bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation of Cure Induced Stresses in Low Cure Temperature Thermoset Polymer Composites
Authors: Genidy Mohamed S. , Madhukar Madhu S. , Russell John D.
Published: July 2017

Low temperature thermal curing resins (such as LTM-45 ELD and X343-59) are being considered by the aerospace industry for developing prototype parts. By curing at low temperatures, the parts can be cured outside of the autoclave. Therefore, expensive autoclave hardened tooling is not required. Tooling materials such as wood and foam can be used instead. This will dramatically reduce the cost of producing prototype parts. The effect of the standard cure cycles on the cure induced stresses in composites containing such resins is not characterized yet. Most of the cure induced stresses are developed after the polymer reaches the gel point. Any subsequent polymer volume change produces fiber stresses. Stress relaxation acts to reduce stresses developed during cure. Relaxation time increases significantly after the polymer is gelled and thus stress relaxation becomes less effective to reduce cure induced fiber stresses. A closed loop feedback control system has been developed to monitor the cure induced fiber stresses and to determine cure cycles with less residual stresses. In this system, a polymer is cured along a given length of a pretensioned fiber. The cure induced stresses are determined by measuring the fiber tension change. This method was applied to LTM-45 ELD and X343-59 resins during standard two stage cure cycles and during a typical autoclave cure cycle used for 3501-6 epoxy. The cure induced fiber stresses were monitored during these cycles. In addition, the feedback control was used to determine modified cure cycles to reduce these stresses.
Investigations on the Impact Performance of Gas-Assisted Injection Molded Polystyrene Parts
Authors: der Chien Rean , Cheng Ching-Kuo , Chen Shia-Chung , Yeh Hsien-Yang
Published: July 2017

The effects of geometrical factors, introduced by part thickness and various gas channel designs, including semicircular gas channel and rectangular gas channels with different geometry, on the impact properties of gas-assisted injection molded (GAIM) polystyrene parts were investigated via impact energy measurement. Test results were also compared with those of conventional injection molded (CIM) parts and plate parts without gas channel. It was found that gas channel design results in part impact reinforcement and gas-assisted injection molded parts show better impact performance than conventional injection molded parts. Generally speaking, impact strength of GAIM parts increases when the size of the gas channel is increased. Meanwhile, for five gas channel designs, both gas channel designs attached with top rib (shapes D and E) show the higher impact energy and impact value. These two gas channel designs provide the best enhancement effect in impact performance. The present investigation provides a design guideline for choosing the most effective gas channel design to achieve the part impact performance.
Topical Review: Infantile Spasms: Therapy and Outcome
Authors: Riikonen Raili
Published: July 2017

Up-to date information about corticotropin (ACTH) in the treatment of infantile spasms and evaluation of the long-term outcome was provided to answer questions about (1) the efficacy of doses of ACTH in comparison with other drugs, especially with vigabatrin, and the efficacy in patients with tuberous sclerosis; (2) tolerability; and (3) long-term outcome. In two studies, high doses were not more effective than low doses but were more effective in another study. In the follow-up of the studies, there was no difference. In an open, randomized, prospective study, the efficacy and relapse rates of ACTH and vigabatrin treatment did not differ significantly. The high response rates in tuberous sclerosis complex were similar. Both drugs had severe side effects. In the long-term follow-up of 20 to 35 years, one third of the patients died, the intellectual outcome of the remaining patients was normal or slightly subnormal, and one quarter and one third of the patients were seizure free. ACTH should be the first choice for treatment of infantile spasms. The side effects of ACTH, unlike those of vigabatrin, are well known, treatable, and reversible. However, an open, prospective study to compare the efficacy, relapse rate, and long-term outcome of treatment with ACTH and vigabatrin is urgently needed. The frequency of visual field defects after vigabatrin therapy should be evaluated. ( J Child Neurol 2004;19:401-404).
Clinical, Electroencephalographic, and Behavioral Features of Temporal Lobe Epilepsy in Childhood
Authors: Franzon Renata C. , Augusta Montenegro Maria , Guimarães Catarina A. , Guerreiro Carlos A. M. , Cendes Fernando , Guerreiro Marilisa M.
Published: July 2017

This study describes the clinical, electroencephalographic, and behavioral features of 36 children with temporal lobe epilepsy. Patients were divided into two groups: group A, with 6 patients (< 6 years), and group B, with 30 patients (6-18 years). Statistical analysis was performed considering the significance level of .05. Regarding the clinical features of the focal seizures, motor components were more frequently seen in children younger than 6 years of age ( P < .01), whereas automatisms were more frequently seen in patients older than 6 years of age ( P < .05). Associated myoclonic seizures were more frequent in the younger age group ( P < .01). Behavioral disorders such as hyperactivity and aggressiveness and speech delay were more common in the younger age group ( P < .05). Temporal lobe epilepsy in children younger than 6 years of age is more frequently associated with motor components, myoclonic seizures, behavioral disorders, and speech delay. Conversely, temporal lobe epilepsy in older patients has frequent automatisms. ( J Child Neurol 2004; 19:418-423).
Mercury Exposure in Children With Autistic Spectrum Disorder: Case-Control Study
Authors: Ip Patrick , Wong Virginia , Ho Marco , Lee Joseph , Wong Wilfred
Published: July 2017

Although mercury has been proven to be a neurotoxicant, there is a lack of data to evaluate the causal relationship between mercury and autism. We aim to see if there is increased mercury exposure in children with autistic spectrum disorder. We performed a cross-sectional cohort study over a 5-month period in 2000 to compare the hair and blood mercury levels of children with autistic spectrum disorder ( n = 82; mean age 7.2 years) and a control group of normal children ( n = 55; mean age 7.8 years). There was no difference in the mean mercury levels. The mean blood mercury levels of the autistic and control groups were 19.53 and 17.68 nmol/L, respectively ( P = .15), and the mean hair mercury levels of the autistic and control groups were 2.26 and 2.07 ppm, respectively ( P = .79). Thus, the results from our cohort study with similar environmental mercury exposure indicate that there is no causal relationship between mercury as an environmental neurotoxin and autism. ( J Child Neurol 2004;19:431-434).
Temporal Trends in the Incidence and Case Fatality of Stroke in Children and Adolescents
Authors: Kleindorfer Dawn , Khoury Jane , Kissela Brett , Alwell Kathy , Woo Daniel , Miller Rosemary , Schneider Alexander , Moomaw Charles , Broderick Joseph P.
Published: July 2017

A recent study reported that mortality from stroke in children and adolescents decreased by 58% from 1979 to 1998, although it wasn't clear if the case fatality or the incidence of stroke in this age group is decreasing. We report trends of stroke incidence and case fatality in children and adolescents within a large biracial population. The study involved collection of all strokes in the study population between January 1, 1988 and December 31, 1989, July 1, 1993 and June 30, 1994, and January 1, 1999 and December 31, 1999, at all of the regional hospitals serving the Greater Cincinnati/Northern Kentucky population (only the children's hospital in 1988). Study nurses reviewed the medical records of all inpatients with stroke-related discharge diagnoses and abstracted relevant data. A study physician reviewed each abstract to determine whether a stroke or transient ischemic attack had occurred. A total of 54 strokes occurred in children or adolescents younger than 20 years during the three study periods (30% African American, 70% Caucasian, and 56% female). The overall incidence rate of all strokes in children younger than 15 years was 6.4/100,000 in 1999, a nonsignificant increase when compared to 1988. The 30-day case-fatality rates were 18% in 1988—1989, 9% in 1993—1994, and 9% in 1999. We found that the incidence of strokes in children has been stable over the past 10 years. The previously reported nationwide decrease in overall stroke mortality in children might be due to decreasing case fatality after stroke and not decreasing stroke incidence. Based on our data, we conservatively estimated that approximately 3000 children less than 20 years old would have a stroke in the United States in 2004. ( J Child Neurol2006;21:415—418; DOI 10.2310/7010.2006.00091).
Condition monitoring of slow-speed rolling element bearings using stress waves
Authors: Jamaludin N , Mba D , Bannister R H
Published: July 2017

Condition monitoring of rolling element bearings through the use of vibration analysis is an established technique for detecting early stages of component degradation. However, this success is not mirrored at rotational speeds below 16r/min. At such speeds the energy generated from bearing defects might not show as an obvious change in signature and thus becomes undetectable using conventional vibration measuring equipment. This paper presents an investigation into the applicability of stress wave analysis for detecting early stages of bearing damage at a rotational speed of 1.12r/min (0.0187 Hz). Furthermore, it reviews work undertaken in monitoring bearings rotating at speeds below 16r/min.
An integrated use of IDEFO, IDEF3 and Petri net methods in support of business process modelling
Authors: Kim C-H , Yim D-S , Weston R H
Published: July 2017

The paper describes transformation rules that map between IDEFO and IDEF3 integration definitions and Petri net modelling constructs. Use of these rules has enabled the development of an enterprise modelling methodology. This methodology ensures that different yet consistent views of business processes and their underpinning resources can be developed by members of a systems engineering team. In particular, the methodology supports the organized capture of functional models, expressed in IDEFO notation, and links them to the subsequent development of behaviour models expressed in IDEF3 notation. Decomposition rules have also been developed that determine relationships between system elements so that they can be modelled at various levels of granularity. Resultant behaviour models can be translated into an equivalent Petri net form. One target application of the modelling rules and methods has been to model interactions between business partners that share common business processes.
Statistical aspects of fouling processes
Authors: Sheikh A K , Zubair S M , Younas M , Budair M O
Published: July 2017

Fouling in heat exchangers is traditionally characterized by deterministic (linear or nonlinear) kinetic models of fouling deposition and removal processes. This deterministic approach to fouling does not reflect the real situation of heat exchangers subject to fouling. The observations in a real situation of fouling of heat exchangers, when compared with the results obtained from predictive models, show a large discrepancy. This discrepancy in the fouling literature is normally referred to as uncertainty of the process. In this paper an attempt is made to model this uncertainty by characterizing the fouling as a correlated random process. The deterministic kinetic models (available in the literature) are randomized by treating their parameters as random quantities. Three fouling patterns are characterized by Rf(t) = Bt for the linear process, Rf(t) = mtn for the power law process with a falling rate (0 n ≤ 1) and Rf(t) = Rf∗[1 − exp (—t/τ)] for an asymptotic process, where t > 0 and B, m, Rf∗ and τ are the random process parameters with associated distributions. Fouling causes the performance loss of heat exchangers which can be tolerated up to a certain limit (i.e. critical level of fouling, Rfc), and thus it is of interest to find P[R(t) ≤ Rfc] = P(T > t) where T is the time to reach Rfc. Such distributions are developed in this paper, which are validated against the available data in the literature. It is demonstrated that alpha, modified alpha and Weibull are the most appropriate models to characterize the time to reach a critical level of fouling, if the underlying random fouling growth laws are linear, power law and asymptotic respectively. Knowledge of these distributions and the methods to determine their parameters is useful for devising appropriate maintenance and cleaning schedules in a probabilistic framework.
Effect of selenium on vanadium toxicity in different regions of rat brain
Authors: Haider Syed Saleem , Abdel-Gayoum A A , El-Fakhri Mustafa , Ghwarsha Kilani M
Published: July 2017

The protective effect of selenium on the neurotoxicity of vanadium in different brain regions of rats was investigated. The lipid peroxidation was significantly accentuated after intraperitoneal (i.p.) administration of vanadium (1.5 mg kg71 b.wt) for a period of 12 consecutive days to rats. The increase in lipid peroxidation was inhibited by selenium treatment (0.02 mg kg71 b.wt., i.p.) for 12 consecutive days. Vanadium exposure produced a decrease in nonprotein sulfhydryl group. Selenium treatment prevented the depression in nonprotein sulfhydryl group in all the brain regions of the vanadium exposed rats. The concentration of ascorbic acid was decreased after co-administration of selenium and vanadium. These results suggest that selenium protects neuronal cells against neurotoxic effects of vanadium by maintaining the availability of antioxidant nonprotein sulfhydryl groups. The decrease in ascorbic acid levels may have been due to its consumption in forming complexes with vanadium.
Neurological effects of glufosinate poisoning with a brief review
Authors: Watanabe Toshiaki , Sano Takuya
Published: July 2017

Herbicides containing glufosinate ammonium are widely used in many countries including Japan. Many Japanese cases of accidental and suicidal poisoning by glufosinate have been reported since 1989. We report a case of a 64- year old man who ingested glufosinate in an attempted suicide. The patient suffered mental disturbances and hematological changes together with gastrointestinal effects shortly after ingesting the poison, and later developed generalized convulsions, impaired respiration and circulatory failure. During recovery he exhibited loss of short-term memory (retrograde and anterograde amnesia). Neurotoxicity is a characteristic of glufosinate poisoning, although the mechanism is not clear. From the analysis of clinical symptoms of previously published cases, glufosinate toxicity appears to arise both from the active ingredient and the surfactant in the formulation.
Differentiating Elderly Medical and Psychiatric Outpatients With the Beck Anxiety Inventory
Authors: Steer Robert A. , Willman Margaret , Kay Patricia A. J. , Beck Aaron T.
Published: July 2017

To ascertain whether self-reported anxious symptoms differentiated elderly (≥ 60 years old) medical and psychiatric outpatients, the Beck Anxiety Inventory (BAI) was administered to 45 medical outpatients without psychiatric disorders and 117 psychiatric outpatients with mixed DSM-III-R disorders. The coefficient alphas of the BAI for the medical and psychiatric outpatients were 0.86 and 0.90, respectively. The mean BAI score (19.19, SD = 11.71) of the psychiatric outpatients was approximately 2.7 times higher than that (7.20, SD = 6.68) of the medical outpatients. Although the means for 15 of the 21 BAI symptoms were significantly lower in the medical outpatients than in the psychiatric outpatients, a stepwise discriminant-function analysis indicated that only two symptoms— fear of the worst happening and unsteady—contributed unique variance to the differentiation of the two groups. The results are discussed as supporting the use of the BAI with elderly outpatients.
Clinical Efficacy of Halstead's Impairment Index Versus an Empirical Weighting Procedure
Authors: Nadler Jodi D. , Sellers Alfred H. , LaPointe Laura , DePiano Frank A.
Published: July 2017

The Halstead-Reitan Neuropsychological Battery is commonly used to determine the presence or absence of neurocognitive impairment. A principal indicator used to make this determination is the Impairment Index, an index comprising seven measures from the battery. The Impairment Index has been criticized for assuming equality among the measures. Using the original validation sample for the Halstead-Reitan Neuropsychological Battery, a discriminant function analysis was performed to determine the best set of weights for the seven measures. The results showed that the measures are of differential importance in discriminating between impaired and non-impaired subjects. Cross-validation of the obtained weights on a new sample indicated that the two weighting methods do not differ in classification accuracy. The findings suggest that an empirically derived set of weights is probably no more useful than the easier-to-compute equal weighting procedure commonly used.
Personality Assessment Inventory (PAI) Profiles of Adult Female Abuse Survivors
Authors: Cherepon Joseph Adam
Published: July 2017

Personality Assessment Inventory (PAI) profiles of 91 adult female, Caucasian subjects were examined to determine if there were significant differences between those subjects who reported a history of broadly-defined childhood/adolescent abuse and those subjects who did not report a history of abuse. PAI profiles of 44 self-reported survivors of abuse were compared with those of 47 subjects diagnosed with primary affective disorders, but without a reported history of abuse. Since there were significant age differences between the two groups, with the nonabused subjects being older, PAI scores were compared using age of subject as covariate in an Analysis of Covariance design. Significant differences between the groups were obtained on several PAI scales and subscales. In addition, the profiles of abuse survivors closely resembled Morey's PAI Cluster 2, which is associated with a diagnosis of post-traumatic stress disorder (PTSD). The PAI scale scores of the abuse survivors were believed to reflect the “acting-out” and “acting-in” tendencies reported in prior PTSD literature. The implications for evaluation of abuse survivors are discussed.
Comparative Test-Retest Stability of Four WAIS-R Selected Subtest Short Forms in Persons 75 to 87 Years of Age
Authors: Ryan Joseph J. , Paolo Anthony M. , Van Fleet Jay N.
Published: July 2017

We compared the retest stability of selected WAIS-R short forms including the Kaufman, Ishikuma, & Kaufman-Packer; Reynolds, Wilson, and Clark; and Silverstein tetrads; and the Ward seven subtest abbreviation. Subjects were 61 normals with means for age and education of 78.93 years ( SD = 3.46) and 9.74 years ( SD = 1.91), respectively. The average retest interval was 65 days. Stability coefficients were .87, .94, and .89 for the Kaufman, Reynolds, and Silverstein tetrads, respectively. Coefficients on Ward's abbreviation were .88 on the Verbal, .91 on the Performance, and .93 on the Full Scales. Retest means changed by 3.03 points on Kaufman, -.38 on Reynolds, and .56 on Silverstein. Average changes were 2.36, 3.49, and 3.36 on the Ward Verbal, Performance, and Full Scale estimates. Short form stability in each instance was comparable to that of the standard WAIS-R.
A Psychometric Comparison of the Beck Depression Inventory and the Inventory for Diagnosing Depression in a College Population
Authors: Pace Terry M.
Published: July 2017

The relationship between the Beck Depression Inventory (BDI) and the Inventory for Diagnosing Depression (IDD) was evaluated in a college population. The BDI is an established self-report depression instrument. The IDD is a relatively new self-report depression instrument. The IDD was designed to address the BDI's lack of full correspondence with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) ( DSM-III) through DSM-IV criteria. The two instruments were found to be highly correlated and Cronbach's alpha was found to be high for each instrument. The diagnostic performance of three BDI cutoff scores was found to vary considerably when compared to IDD diagnostic criteria. Implications for selection and use of self-report depression inventories are discussed.
Active Feedback Control Using Adaptive Filtering
Authors: Wang Fenglin , Mechefske Chris K
Published: July 2017

In this paper we apply a filtered-X algorithm to an active feedback control structure and derive the transfer function of a closed-loop control system. Simulation studies are then carried out on the closed-loop property while varying the parameters (input frequency, delays in plant, amplitude and phase of modeling filter). Several properties of adaptive feedback control are revealed. Experimental studies on feedback active noise control of noise in a finite duct and a small enclosure are described, and outstanding active noise control effects are achieved. Experimental results of closed-loop frequency response are also provided.
Imiquimod Therapy for Molluscum Contagiosum
Authors: Liota Elizabeth , Smith Kathleen J. , Buckley Ronald , Menon Padmen , Skelton Henry
Published: July 2017

Background:

Molluscum contagiosum virus (MCV) is a large double-stranded DNA virus that is a member of the family Poxviridae, and which has a worldwide distribution. As with other poxviruses, MCV does not appear to develop latency but evades the immune system through the production of viral specific proteins.

Objective:

To evaluate the therapeutic efficacy of imiquimod 5% cream for MCV.

Methods:

Thirteen children >5 and <10 years old, 19 immune-competent adults and four adults with advanced, but stable HIV-1 disease with >10 MCV lesions were treated with topical 5% imiquimod cream three times weekly for up to 16 weeks.

Results:

Fourteen of 19 immune-competent adults, four of four adults with HIV-1 disease, and six of 13 children had resolution of their MCV lesions in <16 weeks of imiquimod therapy. Children tended to have more pruritus and inflammatory reactions with imiquimod, although most treated lesions appeared to respond. The development of new MCV lesions resulted in a lower overall resolution of the lesions in children. Imiquimod appeared to be the most efficacious in patients with HIV-1 disease and in the genital area in immune-competent adults.

Conclusion:

Although topical imiquimod appears to have some efficacy in the therapy of MCV, in children the pruritus correlated relatively well with the development of new lesions. In adults, areas that would be expected to have better penetration appeared to respond more consistently. Although the HIV-1-positive patients had the largest clinical lesions at the onset of therapy, as a group they had the best overall response to therapy.
John Updike on Psoriasis: At War with My Skin, from the Journal of a Leper
Authors: Jackson Robert
Published: July 2017

Background:

In recent years patients have become more involved in the impact, description, diagnosis, and management of their own disease.

Objective:

This article will briefly record the personal observations of John Updike, a highly regarded, perceptive twentieth-century American writer, on how moderately severe psoriasis has affected his life and also his thoughts about his disease and its treatment.

Conclusion:

Updike's description of his psoriasis gives a valid insight into a patient's view of psoriasis.
Effects of Benzoyl Peroxide on Lipogenesis in Sebaceous Glands Using an Animal Model
Authors: Burkhart Craig G. , Butcher Cynthia , Burkhart Craig N. , Lehmann Paul
Published: July 2017

Background:

Benzoyl peroxide is the most widely used topical agent for acne since the 1960s. Concomitant treatment of benzoyl peroxide with oral, or topical antibiotics diminishes the multiplication of antibiotic-resistant strains of Propionibacteria acnes. Besides being antibacterial, the chemical also functions as a peeling agent, has comedolytic activity, reduces free fatty acid levels, and is touted to be sebosuppressive.

Objective:

The purpose was to determine the ability of topically applied benzoyl peroxide to suppress lipogenesis of the sebaceous glands.

Methods:

The data were obtained employing an animal model for human sebaceous glands, namely, the flank organs of female golden Syrian hamsters.

Results:

Our results reveal no inhibition of lipogenesis in sebaceous glands by topical application of benzoyl peroxide.

Conclusion:

Despite many functions beneficial in acne therapy, benzoyl peroxide does not possess sebosuppressive capabilities. With the advent of water-soluble organic peroxides revealing similar antimicrobial activity to benzoyl peroxide, all therapeutic parameters (save for sebosup-pression) will need to be assessed to weigh the benefits of these second-generation acne-fighting peroxides.
Hypopigmented Mycosis Fungoides: Case Reports and Literature Review
Authors: Qari Mohammed S. , Li Ning , Demierre Marie-France
Published: July 2017

Background:

Hypopigmented mycosis fungoides is a rare variant of mycosis fungoides (MF) that usually has a predilection for young individuals with dark complexion.

Objective:

The aim is to describe new cases of hypopigmented MF with confirmed T-cell receptor gene rearrangement analysis.

Methods:

This article includes case reports and a literature review.

Results:

Three out of four hypopigmented MF patients had a positive TCR gene rearrangement. A fifth patient is reported who had hypopigmented mycosis fungoides and classical Pautrier microabscesses, for whom no TCR gene rearrangement analysis was performed.

Conclusion:

Although hypopigmented MF has a predilection for dark-complexioned populations, it can also affect Caucasian patients. In challenging cases, polymerase chain reaction can be a useful method for detecting early cases of hypopigmented MF.
Arthropod Bites Manifesting as Recurrent Bullae in a Patient with Chronic Lymphocytic Leukemia
Authors: Blum Robin R. , Phelps Robert G. , Wei Huachen
Published: July 2017

Background:

We report a patient with chronic lymphocytic leukemia (CLL) that developed recurrent vesicobullous lesions that histologically demonstrated features of an exaggerated response to an arthropod bite.

Objective:

Patients with CLL can present with many cutaneous manifestations, including specific and nonspecific lesions. Although rare, patients with CLL can develop an exaggerated response to an arthropod bite.

Conclusion:

Emphasis needs to be placed on the clinical recognition of arthropod bites as an unusual cutaneous manifestation of CLL, as they provide the physician with both a diagnostic and a therapeutic challenge. Patients often deny being bitten and, thus, the biopsy results conflict with the patient's history. Additionally, as there is no specific treatment, both the patient and physician are faced with a similar dilemma. Although our patient initially responded well to corticosteroids, his lesions significantly improved while being treated with dapsone.
Toxic Epidermal Necrolysis of the Scalp following Anticonvulsant Use and Cranial Irradiation
Authors: Trent Jennifer T. , Bowes Leyda E. , Romanelli Paolo , Kerdel Francisco A.
Published: July 2017

Background:

Toxic epidermal necrolysis (TEN) of the scalp is rare but it has been shown to occur in patients who had been given a combination of cranial radiation and anticonvulsant therapies.

Objective:

We present a 62-year-old man who received cranial irradiation following craniotomy for glioblastoma multiforme. After he was prescribed the anticonvulsant phenytoin for postsurgical seizure prophylaxis, the patient developed TEN which began on the scalp before spreading to involve other parts of his body. Our second case was a 55-year-old woman who had been diagnosed with lung carcinoma with metastasis to the brain. She was treated with cranial irradiation and the anticonvulsant carbamazepine. TEN developed first on the scalp and then became generalized.

Conclusions:

While the combination of radiation and anticonvulsants leads to an increased risk of developing TEN, cranial irradiation appears to be the localizing factor in the development of TEN of the scalp.
Arachidonic Acid-Derived Bioactive Lipids: Their Role and the Role for Their Inhibitors in Dermatology
Authors: Smith Kathleen J. , Skelton Henry
Published: July 2017

Background:

In addition to corticosteroids, there are increasing numbers of anti-inflammatory agents that specifically target bioactive lipids generated from arachidonic acid. Knowledge of the diverse mechanisms of action of these different bioactive lipids holds promise in the therapy of a wide spectrum of cutaneous and systemic disorders.

Objective:

Therapeutic manipulations of these lipid molecules through inhibition, stimulation, or direct replacement have broad physiologic effects. These therapeutic strategies not only modulate inflammation, pain, and hemostatic parameters, they also play a role in cardiac, respiratory, renal, and gastrointestinal function and disease, as well as in angiogenesis and in factors that control cell growth and apoptosis important in carcinogenesis.

Conclusion:

Newer drug discovery methods, including combinatorial chemistry with molecular modeling, have made it possible to develop inhibitors and analogs with increasing specificity and bioactivity and decreasing toxicity. Although the application of these analogs and inhibitors for cutaneous disease is limited today, either as primary agents or adjuvant therapy, these drugs will have a place in our therapeutic regimes of the future. We present a review of the therapeutic agents now available from manipulation of these bioactive lipids, and their role and future in dermatology.
Use of Eye Movement Desensitization and Reprocessing (EMDR) in the Treatment of Dermatologic Disorders
Authors: Gupta Madhulika A. , Gupta Aditya K.
Published: July 2017

Background:

The use of psychological therapies in dermatology is being increasingly recognized because stress and negative emotions are major factors in a wide range of dermatologic disorders. Eye movement desensitization and reprocessing (EMDR) is a relatively new psychological intervention which was first described to be effective in post-traumatic stress disorder, a condition associated with extremely stressful life situations.

Objective:

We evaluated the efficacy of EMDR in primary dermatologic disorders where psychological stress plays an important part in the pathogenesis of the disorder, and in clinical situations where the dermatologic symptom is the feature of a stress-related psychiatric disorder.

Methods:

Four patients (two patients with atopic dermatitis and psoriasis, respectively, whose symptoms were exacerbated by stress, one patient with acne excoríee associated with body image pathology as a result of childhood emotional abuse, and one patient with generalized urticaria associated with post-traumatic stress disorder) were treated using the standard EMDR protocol with 3–6 sessions for a period ranging from 4 to 12 weeks, and followed up for 6–12 months after the end of EMDR therapy.

Results:

All 4 patients experienced a marked improvement in their symptoms after 3–6 sessions of EMDR, within a period of ⩽3 months, and maintained improvement during followup periods of 6–12 months.

Conclusion:

Our preliminary findings suggest that EMDR may be beneficial in the treatment of a wide range of stress-mediated dermatologic symptoms.
Paraneoplastic Pemphigus: A Refractory Autoimmune Mucocutaneous Disease
Authors: Ng Patricia P.L. , Rencic Adrienne , Nousari H. Carlos
Published: July 2017

Background and Objective:

We report on a 42-year-old man with Stage IIA non-Hodgkin's lymphoma who developed a severe mucocutaneous blistering eruption. His diagnosis, paraneoplastic pemphigus, was based on clinical, histological, and immunofluorescence findings and confirmed by immunoprecipitation. Despite maximal therapy with plasmapheresis, corticosteroids, and mycophenolate mofetil and the subsequent addition of cyclophosphamide and cyclosporine, the condition was fatal.

Conclusion:

This case illustrates the refractory nature of this disease and the inadequacy of existing therapies.
Olmsted Syndrome—Palmoplantar and Periorificial Keratodermas: Association with Malignant Melanoma
Authors: Dessureault Josee , Poulin Yves , Bourcier Marc , Gagne Eric
Published: July 2017

Background:

Olmsted syndrome is a rare congenital disorder with mutilating palmoplantar keratoderma, periorificial keratotic plaques, and other variable features.

Objective:

We describe a 65-year-old woman with Olmsted syndrome complicated by the occurrence of a malignant melanoma inside the plantar keratoderma. To our knowledge, this is the first reported case of such an occurrence in Olmsted syndrome. The published cases of this rare disorder are reviewed.

Conclusion:

An association between malignant epithelial tumors and Olmsted syndrome has already been reported. The association of malignant melanoma with other types of palmoplantar keratodermas has been reported. This may suggest a predisposition to melanocytic as well as squamous cell malignancies in congenital keratodermas. Oral retinoids appear to be the most promising treatment for Olmsted syndrome and for other symptomatic keratodermas.
Pyodermatitis—Pyostomatitis Vegetans: Two Cases and a Review of the Literature
Authors: Nigen Simon , Poulin Yves , Rochette Linda , Lévesque Marie–Hélène , Gagné Éric
Published: July 2017

Background:

Pyodermatitis–pyostomatitis vegetans (PD–PSV) is a rare vegetating, pustular, eosinophilic, mucocutaneous dermatosis characterized by mucocutaneous lesions of the genital, axillary, and oral regions, as well as on the scalp.

Objective:

We report two patients who were diagnosed with PD–PSV. The published cases of this rare disorder are reviewed.

Results:

The first patient presented with vegetating pustular plaques of the scalp, vulva, and mouth. The second patient initially showed pustules on fingers and then on toes. Vulva and mouth were later involved. There was no gastrointestinal involvement in either case. In both cases, histology revealed eosinophilic spongiosis with eosinophilic microabscesses and pseudoepitheliomatous hyperplasia. Direct immunofluorescence was negative.

Conclusion:

Pyodermatitis–pyostomatitis vegetans is a rare disorder of unknown cause. It bears similarities to pemphigus vegetans but histology, direct immunofluorescence, and clinical history show the differences. Response to treatment is generally rapid. In several reported cases, an inflammatory gastrointestinal disorder is found in association with the mucocutaneous signs.
Safety and Efficacy of Tacrolimus Ointment 0.1% (Protopic™) in Atopic Dermatitis: A Canadian Open-Label Multicenter Study
Authors: Tan Jerry , Langley Richard
Published: July 2017

Background:

Most previously published trials of topical tacrolimus in atopic dermatitis were of relatively short duration and comprised a limited population with moderate-to-severe disease.

Objective:

The goal of the study was to evaluate the safety and efficacy over a 6-month period of tacrolimus 0.1% ointment in children and adults with a broader severity spectrum of atopic dermatitis.

Methods:

An open-label multicenter trial in patients 2 years and older was used. Primary safety and tolerability assessments included skin infection and application site adverse events. Efficacy parameters were body surface area involvement, pruritus score, and overall reponse.

Results:

There were 240 patients recruited at 23 study sites. Significant improvement from baseline was noted for all efficacy endpoints in both pediatric and adult patients. Skin infections occurred in 26% of patients. Burning sensation with product application, reported by 38% of patients, was transient and of mild-to-moderate severity in the majority.

Conclusion:

Tacrolimus 0.1% ointment was safe, well tolerated, and efficacious in treatment of atopic dermatitis in children and adults over six months.
Successful Treatment of von Zumbusch Pustular Psoriasis with Infliximab
Authors: Trent Jennifer T. , Kerdel Francisco A.
Published: July 2017

Background:

Von Zumbusch pustular psoriasis is a severe, generalized form of psoriasis. Patients may also suffer from systemic complications, such as fever, arthropathy, congestive heart failure, and infections, which can ultimately prove fatal. Generalized pustular psoriasis can often be recalcitrant, making treatment difficult.

Objective:

The purpose of this study was to demonstrate the efficacy of infliximab in treating generalized pustular psoriasis.

Methods:

Four consecutively admitted patients with generalized pustular psoriasis were treated with infliximab 5 mg/kg intravenous infusion. ResultsAfter treatment with infliximab, white blood cell count, sedimentation rate, C-reactive protein, and vital signs normalized in all 4 patients within 24 h of the infusion. PASI scores on discharge had improved in all 4 patients.

Conclusion:

All 4 patients with generalized pustular psoriasis had rapid and positive responses to infliximab without any significant side effects. This experience adds support to the use of infliximab for generalized pustular psoriasis.
Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population
Authors: Freiman Anatoli , Yu John , Loutfi Antoine , Wang Beatrice
Published: July 2017

Background:

Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population.

Objectives:

The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice.

Methods:

Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis.

Results:

The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis.

Conclusions:

The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.
Patient Satisfaction with Psoriasis Therapies: An Update and Introduction to Biologic Therapy
Authors: Finlay Andrew Y. , Ortonne Jean-Paul
Published: July 2017

Background:

Psoriasis is a chronic, immune-mediated skin condition that often requires lifelong treatment. Many patients report dissatisfaction with traditional nonbiologic therapies because they are ineffective for their psoriasis, are associated with side effects, or impact negatively on quality of life.

Objectives:

The aim of this article is to review the effect on patient quality of life of traditional nonbiologic psoriasis therapies and to discuss the impact of biologic psoriasis therapies on patient satisfaction.

Methods:

A review of the literature is presented.

Results:

Traditional nonbiologic psoriasis therapies can negatively impact quality of life due to a variety of factors including inconvenience and toxicity. Biologic agents have been developed that target the immunopathogenesis of psoriasis. Based on favorable efficacy and safety results in clinical trials, some of these agents are now approved for clinical use. Evidence suggests that patients receiving biologic therapies experience significant improvements in health-related quality of life.

Conclusion:

Biologic agents offer new hope for patients with psoriasis that their chronic condition can be controlled in a manner that improves their quality of life and may lead to high levels of satisfaction with their treatment.
Stephen Rothman's Text on Physiology and Biochemistry of the Skin
Authors: Jackson Robert
Published: July 2017

Background:

Forty-nine years ago the first complete and authoritative English text on the physiology and biochemistry of the skin was published by Stephen Rothman, an early basic researcher in dermatology.

Objective:

The purpose of the article is to learn more about Stephen Rothman and his 1954 text, to learn more about what was known and not known then, to learn more about what was considered significant, and to learn more about what was popular at that time.

Conclusion:

Considering the techniques available and the knowledge base, Rothman's 1954 text shows that basic dermatology research 50 years ago had developed to a reasonably sophisticated degree.
Cost Effectiveness of Elidel in the Management of Patients with Atopic Dermatitis in Canada
Authors: Coyle Douglas , Barbeau Martin
Published: July 2017

Background:

With increasing pressure on health care resources, it is necessary to demonstrate that new treatments are both effective and cost effective. ObjectiveThe purpose of this study was to assess the cost effectiveness of pimecrolimus (Elidel) compared to usual therapy in the treatment of both adults and children with atopic eczema in Canada.

Methods:

Analysis was performed using a decision model which estimated the incremental cost per quality adjusted life year (QALY) gained from both a societal and health care perspective.

Results:

For children, Elidel leads an incremental cost per QALY of $38,000 from a societal perspective. For adults, the incremental cost per QALY was $35,000.

Conclusion:

Elidel will lead to an overall increase in costs but with an improvement in clinical outcomes. The cost effectiveness ratios for Elidel were consistently below $50,000 per QALY gained. Given previous funding decisions in Canada, Elidel may be considered a cost-effective use of health care resources.
Photosensitivity to Exogenous Agents
Authors: Lankerani Lela , Baron Elma D.
Published: July 2017

Objective:

To better understand cutaneous photosensitivity reactions, a review of its etiologic factors, clinical characteristics, pathogenesis, and treatment modalities was undertaken.

Methods:

Articles discussing the above aspects of phototoxic and photoallergic reactions were used to demonstrate what is currently known about photoinduced reactions and how to treat them.

Results:

Upon interaction of solar UV radiation with the chemical that is present in significant levels on the skin, one of two known reactions may occur in susceptible patients: a phototoxicity and/or photoallergy. Phototoxic and photoallergic reactions can be diagnosed separately on the basis of pathogenesis, clinical characteristics, and histology. Examples of drugs capable of inducing a phototoxic reaction include amiodarone, retinoids, nonsteroidal antiinflammatory agents, diuretics, and antibiotics. Substances known to cause a photoallergic response are fragrances, sunscreens, topical antimicrobials, NSAID, and psychiatric medications, such as chlorpromezine.

Conclusion:

Photoinduced reactions produced by exogenous chemicals are common skin disorders. Definitive therapy requires identifying and removing the offending agent, either the photosensitizing chemical or light. The use of fully protective clothing and a sunscreen of high SPF are important measures when light exposure is inevitable.
An Unusual Cause of Refractive Chronic Bilateral Leg Ulceration
Authors: Sabet Laila M. , Wexler Denise , Salama Samih , Gan Bing Siang
Published: July 2017

Background:

Ulceration of the lower extremities is a common disorder that can be very painful. It occurs most frequently in the elderly population as a result of venous hypertension. We report an unusual case of a 32-year-old man with an 11-year history of extensive, painful, bilateral leg ulcers resistant to conventional treatment necessitating above-knee amputation of the left leg. Eventually, the patient was treated with prednisone, which led to almost complete healing of the ulcers of the right leg.

Objective:

The objective of this report is to discuss a rare cause of chronic bilateral leg ulceration.

Methods:

Detailed histopathologic examination showed a complex pattern of overlapping features of several specific dermatologic conditions, including necrobiosis lipoidica (NL), necrobiotic xanthogranuloma (NXG), and the destructive form of granuloma annulare (GA).

Conclusion:

The characteristics of our patient suggest a variant of a cutaneous necrobiotic disorder that has not been previously reported. When clinicians are confronted with recalcitrant ulcerations in the lower extremity, this group of disorders should be considered in the differential diagnosis.
Metastatic Zosteriform Squamous Cell Carcinoma in an Immunocompetent Patient
Authors: Cohen Joel L. , Barankin Benjamin , Zloty David M. , Mikhail George R.
Published: July 2017

Background:

Although described in several reports of internal malignancies metastasizing to the skin, zosteriform metastases have been reported in only two cases of cutaneous squamous cell carcinoma (SCC). In both of these reports, the patients were immunosuppressed related to renal transplantation.

Objective:

We present a case of an immunocompetent patient with zosteriform metastases originating from a recurrent cutaneous SCC. The lesions were present along the maxillary division of the trigeminal nerve.

Methods:

Biopsies from eight lesions were studied using hematoxylin and eosin (H&E) and with immunohistochemistry.

Results:

Neural involvement was detected in H&E preparations before and during excision of the metastatic nodules by Mohs micrographic surgery. The tumor cells reacted with antikeratin antibodies. The patient has had no evidence of recurrence or metastases 30 months following surgery.

Conclusion:

To our knowledge, this is the first case of cutaneous SCC with zosteriform metastases in a patient with an intact immune system. SCC should be included in the differential diagnosis of lesions presenting in a dermatomal distribution.