bluuebunny/crossref_metadata_2025 huggingface dataset:
Hierarchical Relationship of Negative Emotion Perception from Violent Video Games
Authors: Lin Hong-Wen , Luarn Pin , Lin Yu-Ling
Published: July 2017

Video games featuring violent contents have become more and more prevalent among children and teenagers. It is therefore imperative to ponder on questions such as ‘Are violent video games dangerous digital games?’ and ‘What negative emotions do they trigger in gamers?’ As such, this study aims to explore the negative emotions that violent video games trigger in gamers and determine the cause for each negative emotion. For the purpose of this research, Resident Evil, a violent video game, has been chosen as the focus. Taking the gamer’s perspective, the study aims to explore and construct a thorough network structure (game triggered event—gamer’s personal belief—feeling of negative emotions) of gamer’s emotions, the structure of gamers’ emotional cluster and the correlation and level of inter-influence between relevant factors. Results of the study reveal that the overall hierarchical value map (HVM) not only presents a comprehensive gamer emotional network structure but also offers a clear illustration of how key game activating events (enemies, stage mission, BOSS level monsters, horror atmosphere, third-person view) lead to the formation of gamers’ personal beliefs of character death, high difficulty, trigger negative emotion, being frightened, enemy ambush and tough enemies, which ultimately lead to negative emotions such as fear, worry, anger, disgust and frustration on gamers’ part. In addition, among the five gamer emotional clusters, the clusters of fear and anger had the heaviest influence on the gamers. The correlation between factors and influence showed different levels of significance.
A Competency Model for Management Education for Sustainability
Authors: Sharma Radha R.
Published: July 2017

Management education needs transformation to avoid socio-economic volatility in this globalised world and to deal with the crises of responsibility and sustainability. Despite rising demand and increasing popularity, management education has been under scathing attack for eroding values and ethics, and focus on imparting knowledge and skills for improving the bottom line of the firms ignoring the triple bottom line. The value crisis leading to economic meltdown reinforced the need for a paradigm shift in management education, which required responsibility to be embedded in the management curriculum for sustainability. United Nation’s supported ‘Principles for Responsible Management Education’ (PRME) initiative created a movement across the globe among scholars, practitioners and policy makers. The moot question arose “What are the competencies that need to be developed?” The article presents a competency framework and a (Cognitive, Affective, Moral and Behavioural competencies) CAMB competency model developed by the author (Sharma, 2015) based on the PRME principles which has been validated by scholar academics and practitioners from across geographies and can be adopted by business schools nationally and internationally.
Degrees of Acceptance: Variation in Public Attitudes toward Segments of the LGBT Community
Authors: Lewis Daniel C. , Flores Andrew R. , Haider-Markel Donald P. , Miller Patrick R. , Tadlock Barry L. , Taylor Jami K.
Published: July 2017

The lesbian, gay, bisexual, transgender (LGBT) community includes a diverse set of groups, including distinct groups based on sexual orientation and/or gender identity, but it is not clear whether the public makes distinctions in their attitudes toward these subgroups. If they do, what factors motivate individuals to evaluate gays and lesbians differently from transgender people? This study analyzes Americans’ attitudes toward these communities, and it evaluates their support for nondiscrimination protections. We find that public attitudes are significantly more negative toward transgender people and policies pertaining to them than they are toward gay men and lesbians and related policies. The analyses reveal that differences in these attitudes are associated with social contact effects, variation in cognitive consistency, elite cues, and the varying magnitudes of key political factors, such as religiosity and partisanship.
The Response to Conflict Scale
Authors: Birchler Gary R. , Fals-Stewart William
Published: July 2017

This study details the psychometric evaluation of the Response to Conflict Scale (RTC), a 24-item measure of maladaptive responses to marital conflict. The inventory showed high internal consistency, test-retest reliability, construct and discriminant validity, and classification efficiency. Clinical utility of the RTC is also discussed.
MCMI-II Personality Traits Associated with the MMPI-2 Masculinity-Femininity Scale
Authors: Blais Mark A.
Published: July 2017

There has been limited research into the behavioral correlates associated with the Masculinity-Femininity ( Mf) scale of the MMPI (and the MMPI-2). In this study, both the Millon Clinical Multiaxial Inventory—II (MCMI-II), a frequently used self-report measure of personality functioning, and the Minnesota Multiphasic Personality Inventory–2 (MMPI-2) were administered to a group of 76 female psychiatric inpatients. The sample was divided based upon MMPI-2 Mf scale T scores. Subjects with a T score >50 were assigned to the high- Mf group ( n = 28), whereas subjects with a T score >50 were assigned to the low- Mf group ( n = 48). The two groups were compared across the 13 personality disorder scales of the MCMI-II. The results showed that subjects in the high- Mf group had significantly higher scores on the MCMI-II Narcissistic, Antisocial, Aggressive/Sadistic, and Paranoid personality disorder scales. A correlational analysis revealed that the MMPI-2 Mf scale was significantly correlated with these four MCMI-II personality disorder scales. These results are discussed in light of their clinical implications and the limitations of the study.
Do Patients With HIV-Associated Minor Cognitive/Motor Disorder Exhibit a “Subcortical” Memory Profile? Evidence Using the California Verbal Learning Test
Authors: Delis Dean C. , Peavy Guerry , Heaton Robert , Butters Nelson , Salmon David P. , Taylor Michael , Stout Julie , Mehta Parag , Ryan Lee , White Desiree , Atkinson J. Hampton , Chandler James L. , McCutchan J. Allen , Grant Igor , Group HNRC
Published: July 2017

A new diagnostic category for HIV seropositive patients–Minor Cognitive/Motor Disorder (MCMD)—was recently proposed by an AIDS task force sponsored by the American Academy of Neurology. Based on past memory research with HIV+ patients who were diagnosed according to the Center for Disease Control (CDC) definition of AIDS, we predicted that HIV+ patients who met the new criteria for MCMD would exhibit a “subcortical” memory profile (i.e., they would display primarily a retrieval deficit). This hypothesis was generally supported, but with some exceptions. The HIV+ patients with MCMD were found to have a mild encoding deficit (suggestive of some cortical involvement) superimposed on a pronounced retrieval deficit (suggestive of more extensive subcortical involvement). These findings are consonant with those from a recent neuropathological study indicating an increase in cortical involvement, in addition to predominately subcortical involvement, in more advance stages of the HIV disease process.
Effects of Information About Validity Scales on Underreporting of Symptoms on the MMPI-2
Authors: Baer Ruth A. , Wetter Martha W. , Berry David T. R.
Published: July 2017

The effects of two levels of information about the validity scales of the MMPI-2 on underreporting of symptoms were investigated in a college-student population. Subjects who were instructed and offered incentives to underreport were given no information, general information, or detailed information about the validity scales and were compared to a standard-control group. Results suggested that traditional and supplementary underreporting scales of the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) are effective in discriminating standard subjects from uncoached underre-porters, but are much less effective in discriminating standard subjects from subjects given either general or detailed information about the underreporting scales. The findings suggest that coaching may enable some subjects to underreport symptoms without detection, but that at least one scale ( Wsd) shows promising resistance to coaching.
The Use of Photographs of Facial Expressions as a Response Scale
Authors: Schouwstra Sanneke J. , Hoogstraten Johan , Hartman Catharina A. , Stouthard Marlies E. A. , Verhey Hans G. C.
Published: July 2017

The response scale of the Photo Anxiety Questionnaire (PAQ) is nonverbal and is composed of five photographs of a face showing an expression of anxiety. To test if subjects can discriminate accurately between these photographs, a pairwise comparison experiment was conducted with 488 subjects. The results of this experiment warrant the use of the photographs as a response scale. The subjects accurately discriminated between the photographs and ranked the photographs from relaxed to very anxious, as predicted. The agreement between the subjects is not very satisfactory, but this could be less a problem when using the PAQ, as the PAQ photographs are presented in ascending order of anxiety level. Because the female photographs were judged to be more anxious than the equivalent male photographs and the results of the female photographs were more satisfactory, we suggest that only female photographs be used with both male and female respondents.
Relationships Between Continuous Performance Task Scores and Other Cognitive Measures: Causality or Commonality?
Authors: Aylward Glen P. , Gordon Michael , Verhulst Steven J.
Published: July 2017

Relationships among continuous performance test, IQ, achievement, and memory/learning scores were explored in a clinical sample of 1,280 children ( M age = 9.4 years, M grade = 3.9). Intercorrelations among CPT measures were significant, but modest. Correlations between CPT measures and IQ, achievement, and memory/learning scores were also significant, but again generally weak. The CPT number correct scores were more strongly related to other cognitive measures than were commission (i.e., responding to incorrect stimuli) scores. The breadth and extent of associations among the CPT measures and the various cognitive/academic tasks suggest that all, to some extent, require attention and inhibition. The importance of routinely assessing attention and disinhibition in psychological testing is discussed.
Administering the Digit Span Subtest of the WISC-III to Children With Attentional, Emotional, and Learning Difficulties: Should the Examiner Make Eye Contact or Not?
Authors: Plante Lori Goldfarb , Plante Thomas G. , Rahm Philip , Brentar John T. , Couchman Charles
Published: July 2017

This study examined the impact of eye contact versus no eye contact during the administration of the Digit Span subtest of the third edition of the Wechsler Intelligence Scale for Children (WISC-III) to a clinical population of children. Forty-three children, ranging in age from 6 to 16 years, participated in the study, representing a range of attentional, emotional, and learning diagnoses. Participants were administered the Digit Span subtest once with and once without the examiner offering eye contact, in counterbalanced order. Results indicated that respondents generally avoided making eye contact with the examiner, even during the eye contact condition, suggesting that eye contact is at least not preferred during recall of Digit Span numbers. Performance was not impacted by the eye contact behavior of the examiner as respondents generally avoided eye contact. Implications for examiner eye contact behavior during administration of the Digit Span to a clinical population of children are discussed.
Validity of the Kaufman Brief Intelligence Test and a Four-Subtest WISC-III Short Form With Adolescent Offenders
Authors: Thompson Anthony , Browne Janet , Schmidt Fred , Boer Marian
Published: July 2017

Validity of a four-subtest short form (SF4) of the third edition of the Wechsler Intelligence Scale for Children (WISC-III) and the Kaufman Brief Intelligence Test (K-BIT) was evaluated in a sample of 42 young offenders 13 to 17 years of age. A test-retest methodology was used in a design that also yielded K-BIT reliability data for a subset of 24 participants. Results showed that SF4 outperformed the K-BIT on all validity indexes. Although stability coefficients for the K-BIT ranged from .79 to .92, concurrent validity for K-BIT scales with corresponding WISC-III summary IQs was low to modest. It was hypothesized that limited content overlap and the singular format of Matrices contribute to differences between K-BIT Matrices Standard Scores and WISC-III Performance IQs.
Operational Research in Health Education
Authors: Benne Kenneth D.
Published: July 2017

Keynote address made at the annual conference of the Society of Public Health Educators, St. Louis, Missouri, October 25, 1958.
Takotsubo Cardiomyopathy and Non-ST-Segment Elevation Myocardial Infarction: Predictors of Left Ventricular Dysfunction
Authors: Hinojos Andrew , Vanhecke Thomas E , Enright Susan , Elg Nathan , Gifft Kristina , Marengo Benjamin , Rao Swati
Published: July 2017

Background:

Acute coronary syndrome (ACS) from non-ST-segment elevation myocardial infarction (NSTEMI) and Takotsubo (TK) cardiomyopathy present with similar initial clinical features and can result in left ventricular (LV) dysfunction and acute heart failure.

Methods:

This study was a retrospective case-control study that identified patients aged 18 years and older who presented with ACS and underwent cardiac catheterization.

Results:

There were a total of 321 patients in the TK group and 1031 patients in the NSTEMI group. There was significantly worse LV dysfunction in the TK group with average ejection fraction (EF) of 44.35% (±15.11%) versus NSTEMI with an average EF of 47.36% (±13.5%) ( P < .001). The presence of TK yielded of an odds ratio (OR) of 2.373 (95% confidence interval [CI]: 1.165-3.618) and presence of peripheral artery disease (PAD) yielded an OR of 2.053 (95% CI: 1.165-3.618).

Conclusions:

The presence of TK cardiomyopathy and PAD were independent predictors of patients who had LVEF of <35% and elevated B-type natriuretic peptide levels.
Genetic Basis of Darier-White Disease: Bad Pumps Cause Bumps
Authors: Bale Sherri J. , Toro Jorge R.
Published: July 2017

Background:

Darier-White disease, or keratosis follicularis, is a dominantly inherited disorder characterized by brown hyperkeratotic papules and plaques in a seborrheic distribution. The genetic basis of this disorder has recently been elucidated.

Objective:

In this article, we review the history of the search for the genetic basis of Darier-White disease.

Methods:

Previous studies are reviewed in which linkage studies identified the chromosomal location of the disease gene. The methods of physical mapping of the critical gene region and the screening of candidate genes are discussed. Results of recently published data on genotype-phenotype correlation in the disorder are presented.

Results:

Linkage analysis in families, together with development of a physical map of the critical region was important in identifying the causative gene. Screening of candidate genes led to the discovery that mutations in ATP2A2, a gene that encodes the sarco/endoplasmic reticulum Ca2+-ATPase isoform 2, cause Darier-White disease. Abnormalities in the function of this calcium pump are hypothesized to interfere with cell growth and differentiation calcium-dependent processes.

Conclusion:

Genetic and molecular approaches have identified the gene for Darier-White disease and lead to more questions, including “Will this information help in the search for the Hailey-Hailey disease gene?”
Systemic Weber-Christian Disease
Authors: Poorten Mary Anna Ter , Thiers Bruce H.
Published: July 2017

Background:

Weber-Christian disease is a controversial entity that histologically presents as a lobular panniculitis. A systemic variant of this disorder, in which visceral fat is affected, has been reported.

Objective:

A 29-year-old woman with Weber-Christian disease developed a rapidly enlarging abdominal mass during hospitalization for a flare of her skin condition. The mass resolved spontaneously. Radiographic studies demonstrated a mesenteric cyst, which was thought to represent involvement of mesenteric fat by Weber-Christian disease.

Conclusion:

The appearance of an abdominal or pelvic mass in a patient with Weber-Christian disease may be due to visceral involvement by the inflammatory process.
Results of a Pilot Study Reviewing Dermatitis Claims Submitted to the Ontario Workplace Safety and Insurance Board
Authors: Holness D. Linn
Published: July 2017

Background:

Workers who develop occupational skin disease are often eligible for workers' compensation benefits; however, there is little known about the decision-making process for adjudicating claims submitted for work-related skin problems.

Objective:

The objective of this pilot study was to test a file abstraction instrument and determine the nature of information that was available for decision-making.

Methods:

Files submitted to the Ontario Workplace Safety and Insurance Board (WSIB) in 1995 for dermatitis were identified. The last 51 files were abstracted to collect information concerning demographics, physicians seen, information available in the claim file for decision making, as well as type of claim and outcome of the claim.

Results:

Approximately 70% of the claims were “no-lost-time” and one-third of total claims were accepted for compensation. Although there was reasonable information related to the clinical status, most claims had no information that related to workplace issues such as exposures or association with work. Claims that were for lost time or were accepted had more information available.

Conclusions:

The pilot study has demonstrated that there is a lack of information related to workplace issues that would be important in decision-making. The study will be extended to examine the entire year's claims in order to develop a strategy to enhance the understanding of the WSIB and providers regarding the information necessary for decision-making and to determine methods to facilitate its collection.
Per-Gram Cost of Medication is by Itself a Poor Indicator for Comparing Costs of Different Psoriasis Treatments: A Retrospective Cohort Study of the Cost of Psoriasis Treatment with Topical Corticosteroids versus Topical Calcipotriene
Authors: Feldman Steven R. , Sahu Sadhvi , Fleischer Alan B. , Dezii Christopher M.
Published: July 2017

Background:

New treatments are available for psoriasis that complement or replace the use of topical corticosteroids.

Objective:

The purpose of this article is to assess the relative overall cost difference between regimens based on topical steroids and those using the nonsteroidal antipsoriasis medication, topical calcipotriene.

Methods:

Retrospective data on the cost of therapy of psoriasis were attained through analysis of claims from a national pharmaceutical-and-medical-visit claims-database. Episodes of psoriasis treatment were defined and analyzed for patients whose therapy was initiated with either topical calcipotriene or topical corticosteroids of different potency classes.

Results:

The average medication cost per episode was greater for topical calcipotriene ($111/episode) compared to ultrahigh potency ($70/episode), high potency ($57/episode), mid potency ($47/episode), and low-potency, ($75/episode) topical corticosteroids (p < .05). The average total cost of therapy for the topical calcipotriene regimen ($218) fell within the range for the cost of therapy for topical steroid base regimens ($197 to $457); there were no significant differences in the total cost of therapy between topical calcipotriene monotherapy and other treatment groups.

Conclusion:

The per-gram cost of medication is by itself a poor indicator for comparing the cost of different psoriasis treatment regimens. Given the greater safety and efficacy of combination regimens in terms of both short-term improvement and long-term control, initiating psoriasis treatment with a combination regimen of topical calcipotriene combined with an ultrapotent corticosteroid appears to be the most cost-effective approach to psoriasis treatment.
The Effects of Topical Transforming Growth Factor-β2 and Anti-Transforming Growth Factor-β2,3 on Scarring in Pigs
Authors: Brahmatewari Just , Serafini Anton , Serralta Victoria , Mertz Patricia M. , Eaglstein William H
Published: July 2017

Background:

Transforming growth factor-β2 (TGF-β2) has been implicated in the inflammatory response and subsequent scarring during wound healing.

Objective:

The experiment was designed to study the effects of a topical application of TGF-β2 and mouse monoclonal anti-TGF-β2,3 neutralizing antibody (and TGF-β2,3) on the development of fibrosis during healing.

Methods:

Sixteen full-thickness excision wounds were made in the paravertebral and thoracic area of four domestic pigs. On day 0, three wounds each were treated with: a) 5 μg of TGF-β2, b) 5 μg of 2% methylcellulose (mc), or c) 1.2 mg of anti-TGF-β2,3. As a vehicle for treatment of each wound methylcellulose 2% was used. Four wounds served as the untreated air-exposed control. Wounds were biopsied and the tissue sectioned and stained with hematoxylin and eosin on days 7, 14, and 45. Three blinded observers evaluated the wound specimens.

Results:

Using computer-aided point count stereology on days 7, 14, and 45, we found a statistically significant increase (p < .05) in the number of nucleated cells in the TGF-β2-treated wounds as compared to the other control wounds. Wounds treated with anti-TGF-β2,3 had significantly (p < .05) fewer nucleated cells on days 7,14, and 45. Microscopically, the TGF-β2-treated wounds had a larger scar area as compared to anti-TGF-β2,3 and controls.

Conclusion:

Treating wounds with an antibody directed against TGF-β2 might be a useful clinical approach to reduce fibrosis.
The Effect of VAS972 on Allergic Contact Hypersensitivity
Authors: Shivji Gulnar M. , Suzuki Hirotake , Mandel Arkady Sh. , Bolton Anthony E. , Sauder Daniel N.
Published: July 2017

Background:

Contact hypersensitivity (CHS) is a Th1-mediated immune response that can be down-regulated by immunosuppressive agents such as cyclosporine and environmental stimuli such as ultraviolet light. Recently, an immunomodulation therapy, VAS972, has been developed which is believed to down-regulate the Th1 arm of the immune response. This VAS972 involves modifying autologous blood by controlled exposure to the oxidizing agent ozone and UVC light, at an elevated temperature ex vivo. The processed blood is then administered by intramuscular injection.

Objective:

To further evaluate the immune modulating effect of VAS972.

Methods:

We examined the effect of VAS972 treatment on CHS. Contact hypersensitivity was induced with dinitro-fluorobenzene (DNFB) in animals receiving VAS972-processed blood, control blood, or saline. A preliminary study was also conducted to evaluate the effect of plasma and cellular fractions of processed blood.

Results:

Mice injected with VAS972-processed blood demonstrated a significantly lower (46%) CHS response than controls. Histologic examination of challenged ear skin from control mice displayed edema with a significant lymphocytic infiltration, whereas animals administered processed blood demonstrated a reduction in lymphocytic infiltration. Mice injected with either plasma or the cellular fraction of the VAS972-treated blood also demonstrated a significant suppression (49% and 41%, respectively).

Conclusion:

The results of this study demonstrated that VAS972 suppresses CHS and cellular infiltration. Furthermore, the plasma and cellular components of the VAS972 treatment were also able to induce immunosuppression. This further supports the hypothesis that VAS972 down-regulates the Th1 arm of the immune response.
Malignant Melanoma in a Patient with Oculocutaneous Albinism
Authors: Streutker Catherine J. , McCready David , Jimbow Kowichi , From Lynn
Published: July 2017

Background:

Sun-induced malignancies (basal cell and squamous cell carcinomas) are common in oculocutaneous albinism, however, the incidence of malignant melanoma is a topic of controversy.

Objective:

We have reviewed the literature and report a case of a woman with oculocutaneous albinism with an amelanotic melanoma of the anterior chest wall.

Results:

There are only 26 previously reported cases (both case reports and African albino population studies) in 25 patients in the literature. A 27th case with immunohistochemical and ultrastructural evaluation is presented.

Conclusions:

It appears that melanoma, a malignancy for which sun exposure and light colouration are felt to be major risk factors, has a low incidence among a population that is both hypopigmented and often exposed to high levels of ultraviolet light. This low incidence is poorly understood and frequently disputed.
Recent Advances in Bioinformatics in the Medical Research Environment and Applications to the Study of Skin Diseases
Authors: Cuticchia A. Jamie
Published: July 2017

Background:

The computer has become increasingly intertwined in society for the past 30 years. Within the academic health science centre, there is an increasing need for researchers to become skilled at using the Internet as a mechanism for the retrieval of scientific results and the underlying data. The discipline of bioinformatics, which uses computer technology to provide answers to biological questions, has been expanding in scope and utility for the past decade. Increasing numbers of research groups have been investing in bioinformatics infrastructure to aid in the research process. These continuing investments have led to the establishment for the first time of a supercomputing facility within a hospital. Such computational power is being used for the mapping of genes and the study of human disease.

Objective:

A discussion of the increasing role of computational biology in the research environment of the clinician scientist is presented here.

Conclusions:

Though the investment in a supercomputer may not be possible in most research settings, several less expensive alternatives relying on existing desktop computers can provide supercomputer-like performance within nearly any environment.
Are Sterile Conditions Essential for All Forms of Cutaneous Surgery? The Case of Ritual Neonatal Circumcision
Authors: Naimer Sody A. , Trattner A.
Published: July 2017

Background:

Many aspects of cutaneous surgical interventions have been perfected, employed, and then scientifically examined. Conversely, ubiquitous, indiscriminate demand for sterile conditions while performing an invasive procedure remains a field devoid of satisfactory critical appraisal.

Objective:

Ritual neonatal circumcision served as a prototype to assess scientifically the safety of performing a dermatologic intervention under clean, uncontaminated, but nonsterile conditions.

Methods:

Two hundred subjects, mostly neonates, who were unselectively referred for ritual circumcision, served as the study group. The guillotine excisional technique was employed in the community setting under clean, uncontaminated, nonsterile conditions, in line with traditional practice. Follow-up was continued until full recovery.

Results:

No wound infections or septic complications were observed in any of the babies at either early (24–36 hours after the procedure) or late follow-up. Many subjects had an exudative discharge at the healing site several days after the procedure. This is a common finding associated with circumcision and was found to be nonindicative of infection.

Conclusions:

This preliminary study suggests that strict sterile conditions are superfluous for ritual neonatal circumcision, and the effort and expense invested in maintaining an aseptic environment for this sort of intervention may not be justified. Further large-scale investigations are warranted to validate these findings and to determine if they can be extrapolated to other patient populations and other types of cutaneous surgery.
Merkel Cell Carcinoma of the Skin
Authors: Tai Patricia TH , Yu Edward , Tonita Jon , Gilchrist James
Published: July 2017

Background:

Neuroendocrine/Merkel cell carcinoma (MCC) of the skin is an uncommon tumour. Currently, there are only limited data available on the natural history, prognostic factors, and patient management of MCC.

Objective:

To review our experience and build the largest database from the literature.

Methods:

Twenty-eight cases from the London Regional Cancer Center were combined with 633 cases obtained from the literature searched in English, French, German, and Chinese for the years 1966 to 1998. The database included age, sex, initial disease status at presentation to the clinic, site of primary, any coexisting disease, any previous irradiation, sizes of primary/nodal/distant metastases, management details, and final disease status. A new modified staging system was used: stage Ia (primary disease only, size < 2 cm), stage Ib (primary disease only, size > 2 cm); stage II (regional nodal disease), and stage III (beyond regional nodes and/or distant disease).

Results:

Age > 65 years, male sex, size of primary > 2 cm, truncal site, nodal/distant disease at presentation, and duration of disease before presentation (< 3 months) were poor prognostic factors. Surgery was the initial treatment of choice and it significantly improved overall survival (p = .004).

Conclusion:

We identified poor prognostic factors that may necessitate more aggressive treatment. The suggested staging system, incorporating primary tumour size, accurately predicted outcomes.
Multiple Indurated Papules on Penis and Scrotum
Authors: Wei Huachen , Friedman Kaiman A. , Rudikoff Donald
Published: July 2017

Background:

Sarcoidosis is a chronic disease with involvement of multiple organs. Cutaneous lesions may appear as the only manifestation or may be accompanied by systemic disease.

Objective:

To learn that genital sarcoidosis is a rare entity that should be included in the differential diagnosis of genital papules and nodules.

Methods and Results:

A 31-year-old African-American man presented with cutaneous lesions on his penis and scrotum existing for 2 years. The genital lesions were so prominent as to interfere with his sexual life. Sarcoidosis was demonstrated on biopsy.

Conclusions:

Sarcoid lesions may affect any skin area, but are rarely described on the genitalia. Dermatologists should be aware that genital sarcoidosis is a rare entity that should be included in the differential diagnosis of genital papules and nodules. Additionally, genital sarcoidosis may cause urinary problems and may represent a therapeutic challenge.
Cicatricial Pemphigoid Diagnosed by the Use of Indirect Immunofluorescence
Authors: Mutasim Diya F. , Adams Brian B.
Published: July 2017

Background:

A thorough work-up is paramount in the accurate diagnosis of oral erosive diseases.

Objective:

A case of pemphigoid with negative direct immunofluorescence but positive indirect immunofluorescence is presented.

Methods and Results:

A 77-year-old man presented with erosions of the oral and glans mucosa and with esophageal stenosis. Histologic examination revealed nonspecific mucositis. Indirect immunofluorescence was characteristic of pemphigoid.

Conclusion:

This case illustrates the importance of performing a complete diagnostic work-up in the evaluation of patients with oral erosive disease.
Calciphylaxis: Seven New Cases
Authors: Alain Jimmy , Poulin Yves P. , Cloutier Richard A. , Gagné Eric , Baril Joelle
Published: July 2017

Background:

Calciphylaxis is a rare condition occurring most frequently in patients with end-stage renal disease (ESRD). It is characterized by vascular calcifications with a large variety of skin lesions. Even though this entity was first reported almost 50 years ago, the pathogenesis is still not well understood.

Objective:

Having retrieved seven new cases from a single tertiary care hospital, the disease occurs probably more frequently than reported until now. The potential mechanism of action in this disease is discussed, particularly the hypercoagulability state. We also review potential treatments described in the literature.

Methods:

Seven patients with calciphylaxis that occurred at the Hôtel-Dieu hospital between 1992 and 1998 were identified and their case histories reviewed and analyzed.

Conclusion:

Although hyperparathyroidism and imbalance of calcium-phosphorus homeostasis are paramount for calciphylaxis to occur, other mechanisms must be involved because the disease manifests itself in only a minority of ESRD patients. As the majority were under anticoagulation therapy and as we found abnormalities of the coagulation pathway in one patient, we suggest emphasizing these phenomena in the future. Along with evaluation of putative risk factors (abnormalities of the calcium:phosphate axis, diabetes), a detailed evaluation of the coagulation system should be done in every patient with calciphylaxis until more data are available.
Anchorage-Independent Growth of p53-Knockout Dermal Fibroblasts is Reversed by Wild-Type p53
Authors: Bush Jason A. , Li Gang
Published: July 2017

Background:

p53 is a 393-residue nuclear phosphoprotein. Mutation of p53 occurs in over half of all human cancers and thus is a crucial step in the process of cell transformation and tumorigenesis. Since tumorigenesis is a multistep process, it generally requires the mutation of certain key oncogenes and/or tumor-suppressor genes. Using p53-deficient mice, we can investigate the p53-dependent mechanisms leading to tumorigenesis.

Objective:

To examine the unique anchorage-independent growth characteristics of dermal fibroblasts isolated from p53-deficient mice.

Methods:

The growth characteristics of highly confluent cultured dermal fibroblasts from wild-type ( p53+/+) and p53-deficient ( p53−/−) mice were compared by DNA fragmentation assay, colony formation in soft agar, and overexpression of a wild-type p53 transgene in p53-deficient cells.

Results:

p53−/− fibroblasts have a growth rate dramatically higher than p53+/+ cells and detach from plastic cultureware at high density. The detachment of p53−/− cells is not due to apoptosis. Furthermore, these cells have the capacity to grow in soft agar—a hallmark of cell transformation—and this anchorage-independent growth can be reversed by the introduction of a wild-type p53 transgene.

Conclusion:

Dermal fibroblasts isolated from p53-deficient mice show anchorage-independent growth. Therefore, the absence of p53 is sufficient for the initiation of cell transformation in this cell type and establishes this model system as an excellent tool to dissect the molecular steps involved in oncogenesis.
A Case of Cutaneous Mycobacterium Chelonae Abscessus Infection in a Renal Transplant Patient
Authors: Endzweig Carin H. , Strauss Eric , Murphy Frank , Rao Babar K.
Published: July 2017

Background: Mycobacterium chelonae

is an atypical “fast-growing Mycobacteria” that is a rare cause of human infection. There have been several reports of cutaneous infection among immunosuppressed patients, as well as in immunocompetent individuals following trauma. Most cases to date seem to have occurred among renal transplant recipients, raising the possibility that there is something inherent to the renal transplant patient that increases their susceptibility more than other immunocompromised patients.

Objective:

The differential diagnosis of subcutaneous nodules distributed in a sporotri-choid pattern is extensive, particularly in an immunocompromised host. Although several cases of cutaneous M. chelonae abscessus infection have been reported among both immunosuppressed and immunocompetent patients, the clinical presentation has varied, and few cases have reported the appearance of lesions in a sporotrichoid pattern. We present a case of a renal transplant patient with a reported history of trauma to the lower extremities, who presents with subcutaneous nodules distributed in a sporotrichoid pattern. The patient is found to have M. chelonae abscessus infection, fails several treatment regimens, and presents with a recurrence. The literature of M. chelonae infection is reviewed, and the various treatment options are discussed.

Methods:

An initial skin biopsy was stained with Hematoxylin and Eosin and revealed deep dermal abscesses with acid-fast bacilli in clusters. The culture became positive for Mycobacterium chelonae abscesses in four days and was found to be sensitive to multiple antibiotics. The patient underwent surgical excision of 14 nodules, which revealed findings consistent with the skin biopsy, and was subsequently treated with the appropriate antibiotics.

Results:

Despite treatment with a full course of an organism-sensitive antibiotic regimen, the patient returned with persistent and recurrent nodules six weeks later. The patient was then treated as an inpatient with a seven-week course of intravenous antibiotics and was discharged home on a combined intravenous and oral regimen.

Conclusion:

Although M. chelonae abscessus is an extremely rare cause of infection among humans, there seems to be a predominance of cases reported among renal transplant patients. The explanation for this is not entirely clear; however, the organism must be considered as a cause of infection in any renal transplant recipient who presents with subcutaneous nodules. Eradication of the organism presents a tremendous challenge to the clinician, and, as presented here, even with appropriate antibiotics, there is a high rate of recurrence.
Human Papillomavirus Infections: Epidemiology, Pathogenesis, and Therapy
Authors: Severson Jessica , Evans Tanya Y. , Lee Patricia , Chan Teh-Sheng , Arany Istvan , Tyring Stephen K.
Published: July 2017

Background:

Human papillomaviruses (HPV) are common human pathogens and are classified into more than 80 different types. These viruses produce benign warts in many cases and aggressive squamous cell carcinomas in other cases.

Objective:

The goal of this review is to update the reader on the epidemiology, pathogenesis, and therapy of HPV infections. Nonanogenital warts are transmitted by skin-to-skin contact while anogenital warts are usually transmitted sexually. Both types of warts produce much morbidity but rarely undergo malignant transformation. They are commonly treated with surgical or cytodestructive therapy, but immunomodulatory agents, such as imiquimod, have been proven to be very effective in anogenital warts and are being evaluated in nonanogenital warts. Other types of HPV have marked oncogenic potential such that over 99% of all cervical cancers and over 50% of other anogenital cancers are due to infection with oncogenic HPV. Many cofactors, such as cigarette smoking, genetics, and helper viruses, have potential roles in HPV oncogenesis, but their relative contributions are poorly understood. Other control measures for warts and HPV-associated cancers are under study, but the greatest future potential may be from the development of prophylactic and therapeutic vaccines.

Conclusions:

Infection with HPV is very prevalent as are the clinical manifestations of this family of pathogens. Improved therapies for warts (e.g., imiquimod) have recently become available. Vaccines for HPV offer hope for future interventions for warts as well as for prevention of anogenital malignancies.
Tacrolimus in Dermatology
Authors: Tran Quang Hieu Dé , Guay Elizabeth , Chartier Suzanne , Tousignant Jacqueline
Published: July 2017

Background:

Tacrolimus (FK 506), a metabolite of the fungus Streptomyces tsukubaensis, is an anti-T-cell drug. It acts by inhibiting the production of IL-2, IL-3, IL-4, TNFα, and GM-CSF. More potent and with slightly less secondary effects than cyclosporine, it has been the object of considerable interest, especially in conditions that could benefit from the latter.

Objective:

In psoriasis, a placebo-controlled double-blind study has shown oral tacrolimus at 0.1 mg/kg/day to be effective in controlling recalcitrant lesions. In human, small studies have reported tacrolimus ointment to be effective in controlling acute contact dermatitis. Short-term trials of topical tacrolimus in the treatment of atopic dermatitis have recently shown excellent results in both adults and children. In animal studies of hair growth disorders, topical tacrolimus induces anagen and protects from chemotherapy-induced alopecia. Animal studies with the ointment for the prevention of skin graft rejection, lupus dermatoses, and skin papilloma formation have also shown to be promising.

Conclusions:

There are case reports of pyoderma gangrenosum, Sezary's syndrome, and Behçet's disease successfully treated with oral tacrolimus but, because of their small number, they remain anecdotal at this point.
Reduction of Postherpetic Neuralgia in Herpes Zoster
Authors: Vander Straten Melody , Carrasco Daniel , Lee Patricia , Tyring Stephen K.
Published: July 2017

Background:

Persons 50 years of age and older are not only at increased risk of developing herpes zoster, they are also more likely to suffer the long-term morbidity of postherpetic neuralgia (PHN). PHN is pain persisting after the rash of herpes zoster has healed. PHN affects at least 40% of all herpes zoster patients over age 50 and over 75% of herpes zoster patients over age 75; PHN is the single most common neurologic condition in elderly patients.

Objective:

The objective of this review is to evaluate interventions that may reduce or even eliminate PHN. No single therapy has been consistently effective for PHN. The most effective approach appears to be with the use of antiviral therapy early in the course of herpes zoster. The goals of ongoing studies in herpes zoster are to develop interventions that will further reduce the symptoms of PHN and/or to eliminate PHN by prophylaxis using the varicella vaccine.

Conclusions:

Reduction of PHN can best be achieved with the use of antiviral medication early in the course of herpes zoster; other classes of drugs are minimally effective in treating established PHN. Widespread use of the varicella vaccine may lead to secondary reductions in PHN in the distant future.
Multiple Sebaceous Adenomas and Extraocular Sebaceous Carcinoma in a Patient with Multiple Sclerosis: Case Report and Review of Literature
Authors: Akhtar Saad , Oza Krishna K. , Roulier Randolph G.
Published: July 2017

Background:

Sebaceous carcinomas are relatively rare cutaneous tumors; there are fewer than 600 cases reported. They most commonly arise within the meibomian gland of the eyelid; fewer than 150 of the reported cases were extraocular. These tumors have a high incidence of local recurrence and regional metastasis. The relationship of sebaceous tumors and visceral malignancy is well established in the literature.

Objective:

We describe a 44-year-old white female with chronic progressive multiple sclerosis who developed multiple scalp sebaceous adenomas and a solitary sebaceous carcinoma.

Conclusion:

Extraocular sebaceous carcinomas are rare tumors with high incidence of local recurrence and regional metastasis. Surgery with wide surgical margins is the standard treatment. We report the first case of multiple sebaceous tumors in a patient with multiple sclerosis. The presence of sebaceous tumors warrants a search for an internal malignancy. Literature on sebaceous tumors and their relationship with visceral malignancies and immunologic disorders is discussed. Literature on sebaceous carcinoma with special attention to extraocular sebaceous carcinoma is also discussed.
Effects of Finasteride on Apoptosis and Regulation of the Human Hair Cycle
Authors: Sawaya Marty E. , Blume-Peytavi Ulrike , Mullins Diane L. , Nusbaum Bernard P. , Whiting David , Nicholson Donald W. , Lotocki George , Keane Robert W.
Published: July 2017

Background:

A number of studies have provided evidence that apoptosis is a central element in the regulation of hair follicle regression. In androgenetic alopecia (AGA), the exact location and control of key players in the apoptotic pathways remains obscure.

Objective:

In the present study, we used a panel of antibodies and investigated the spatial and cellular pattern of expression of caspases and inhibitors of apoptosis (IAPs), such as XIAP and FLIP, in men with normal scalp and in men with AGA before and after 6 months of treatment with 1 mg oral finasteride treatment.

Methods and Results:

Constitutive expression of caspases-1, −3, −8, and −9 and XIAP was detected predominantly within the isthmic and infundibular hair follicle area, basilar layer of the epidermis, and eccrine and sebaceous glands. AGA-affected tissues showed an increase in caspase (−1, −3, −6, −9) immunoreactivity with a concomitant decrease in XIAP staining. After 6 months of finasteride treatment, both caspases and XIAP were similar to levels exhibited by normal subjects. Immunoblot analysis was performed to determine antibody specificity and cellular expression of caspases. Purified populations of keratinocytes, melanocytes, dermal papilla, and dermal fibroblasts derived from human hair follicles were cultured in vitro and treated with 0.5 μm staurosporin. Time-course experiments revealed that processing of caspase-3 is a principal event during apoptosis of these hair cell types.

Conclusion:

These data suggest that alterations in levels of caspases and IAPs regulate hair follicle homeostasis. Moreover, finasteride appears to influence caspase and XIAP expression in hair follicle cells thus signaling anagen, active growth in the hair cycle.
Induction of Dramatic Hyperpigmentation in a Patient with Generalized Lichen Planus Treated with Re-PUVA
Authors: Carlin Christopher S. , Florell Scott R. , Krueger Gerald G.
Published: July 2017

Background:

Retinoids plus PUVA (re-PUVA) may be used in the treatment of lichen planus in cases that do not respond to monotherapy. Hyperpigmentation is a potential side effect of re-PUVA therapy.

Objective:

A case of remarkably intense transient hyperpigmentation secondary to re-PUVA therapy is presented.

Methods and Results:

An 18-year-old male with lichen planus who had been taking isotretinoin 80 mg per day for seven days developed an exaggerated hyperpigmentation following the third dose of PUVA.

Conclusion:

As the hyperpigmentary reaction did not occur until the third PUVA dose, which was near the steady state of isotretinoin, this case may illustrate a case of photosensitization secondary to isotretinoin alone or isotretinoin in combination.
Psoriasis and Pregnancy
Authors: Tauscher Amanda E. , Fleischer Alan B. , Phelps Kathy C. , Feldman Steven R.
Published: July 2017

Background:

Women comprise half of all psoriasis patients and because the majority of psoriasis cases present before age 40 the disease affects women who may become pregnant. Information regarding the heritability of psoriasis can be used in counseling patients who inquire about the potential risk to their children. Patients with psoriasis who become pregnant will likely notice an associated improvement of their symptoms if any change is noted at all.

Objective:

Because of potential fetal effects, the treatment of chronic psoriasis in pregnancy involves prudent consideration of whether the severity of the disease warrants treatment and selection of the safest treatments available.

Conclusion:

Topical corticosteroids and topical calcipotriene as well as topical anthralin and topical tacrolimus appear to be safe choices for control of localized psoriasis in pregnancy. UVB is the safest treatment for extensive psoriasis during pregnancy, particularly when topical application of other agents is not practical. Short-term use of cyclosporine during pregnancy is probably the safest option for management of severe psoriasis that has not responded to topical or UVB treatment.