Localized Cutaneous Argyria at the Site of a Prior Melanoma Excision Confirmed by Scanning Electron Microscopy With Energy Dispersive X-ray Analysis.

ABSTRACT: Localized cutaneous argyria is a rare condition caused by the accumulation of silver particles in the skin, leading to blue-gray discoloration. Argyria may mimic melanoma and lead to misdiagnosis. We present a patient with a history of melanoma that developed a blue-gray nodule at a prior melanoma graft. The diagnosis was confirmed using scanning electron microscopy and energy dispersive x-ray analysis. These techniques differentiate argyria from melanoma and can be performed on formalin-fixed, paraffin-embedded, tissue sections. Health care providers should be alert that argyria may mimic recurrent melanoma in patients unaware of silver exposure.

Emergence of fentanyl-related deaths in Travis County, Texas and surrounding areas: A retrospective review of postmortem fentanyl-related drug toxicities from 2020 to 2022.

The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl-related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl-related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest-growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl-related deaths over this 3-year period (n = 517). Fentanyl-related fatalities primarily occurred in males in their mid-30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co-positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl-related deaths. Illicit oxycodone (44%, n = 67) and illicit "Xanax" (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks.

The Burden of Skin Disease on Deployed Servicemembers.

INTRODUCTION: Skin diseases have had a significant impact on the health of deployed military service members throughout history. Given the high prevalence historically of cutaneous disease among United States deployed servicemembers, we review the burden of skin disease on the modern military by analyzing the most common dermatologic diagnoses made in deployed settings from 2008 to 2015. Furthermore, we compare the most common dermatologic diagnoses made in the deployed setting with those made by dermatologists and nondermatologists in the civilian healthcare system to highlight the differences between the civilian and deployed military practice environment. METHODS: This study queried the Theater Medical Data Store for International Classification of Diseases, Ninth Revision (ICD-9) codes to determine the total number of dermatologic encounters as part of all medical encounters from 2008 to 2015 in a deployed setting. These data were provided by the Armed Forces Health Surveillance Branch. For all statistical tests, analyses were conducted using R statistical software, with type I error controlled at 5%. RESULTS: From 2008 to 2015, 92 dermatology-specific ICD-9 codes accounted for 429,837 dermatologic diagnoses that were made in a deployed setting, equating to 10% of all diagnoses. The top 20 dermatologic diagnoses were identified, and the percentage of total medical diagnoses (TMD) was calculated. Once the individual diagnoses were categorized, a direct comparison was made between the top 20 most prevalent disease categories among deployed military servicemembers and those of the United States (US) population as a whole, based on claims. The most prevalent diagnoses were compared amongst four different settings: Deployed military, military teledermatology, civilian dermatologists, and civilian nondermatologists. Overall comparison of the prevalence between each of these groups showed an association between setting and diagnosis prevalence. CONCLUSIONS: The total burden of disease based on diagnostic codes from 2008 to 2015 is 429,837 diagnoses. This accounts for 10% of TMD from 2008 to 2015 in the deployed setting. Diagnoses most prevalent in the deployed military setting had more in common with those made by civilian nondermatologists compared with military teledermatology and civilian dermatologists. At 10% of diagnoses made in the deployed military setting in this timeframe, skin disease accounts for a substantial burden on deployed servicemembers. Deployed servicemembers with skin disease should be supported through use of teledermatology resources and improved dermatology education for primary care and deployed medical personnel.

Thermogenic and psychogenic sweating in humans: Identifying eccrine glandular recruitment patterns from glabrous and non-glabrous skin surfaces.

In this experiment, psychogenic (mental arithmetic), thermogenic (mean body temperature elevation of 0.6 °C) and combined thermo-psychogenic treatments were used to explore eccrine sweat-gland recruitment from glabrous (volar hand and forehead) and non-glabrous skin surfaces (chest). It was hypothesised that each treatment would activate the same glands, and that glandular activity would be intermittent. Nine individuals participated in a single trial with normothermic and mildly hyperthermic phases. When normothermic, a 10-min arithmetical challenge was administered, during which sudomotor activity was recorded. Following passive heating and thermal clamping, sweating responses were again evaluated (10 min). A second arithmetical challenge (10 min) was administered during clamped hyperthermia, with its sudorific impact recorded. The activity of individual sweat glands was recorded at 60-s intervals, using precisely positioned, and uniformly applied, starch-iodide papers. Those imprints were digitised and analysed. Peak activity typically occurred during the thermo-psychogenic treatment, revealing physiologically active densities of 128 (volar hand), 165 (forehead) and 77 glands.cm-2 (chest). Except for the hand (46%), glands uniquely activated by one treatment were consistently <10% of the total glands identified. Glandular activations were most commonly of an intermittent nature, particularly during the thermogenic treatment. Accordingly, we accepted the hypothesis that psychogenic, thermogenic and thermo-psychogenic stimuli activate the same sweat glands in both the glabrous and non-glabrous regions. In addition, this investigation has provided detailed descriptions of the intermittent nature of sweat-gland activity, revealing that a consistent proportion of the physiologically active glands are recruited during these thermal and non-thermal stimuli.

Revisiting the dermatomal recruitment of, and pressure-dependent influences on, human eccrine sweating.

Herein we describe two experiments in which the recruitment and pressure-induced modifications of human eccrine sweating were investigated. In one experiment, the longstanding belief that glandular recruitment follows a gradual, caudal-to-rostral (dermatomal) recruitment pattern was re-evaluated. The onset of sweating was simultaneously determined (ventilated capsules) from four spinal (dermatomal) segments (forehead, dorsal hand, lower chest and dorsal foot) during the passive heating of supine participants (N = 8). No evidence was found to support either dermatomal or simultaneous glandular recruitment patterns. Instead, the results were more consistent with individualised (random) patterns of regional activation (P > 0.05), with significant time delays among sites. Such delays in the appearance of discharged sweat may reflect differences in neurotransmitter sensitivity, precursor sweat production or ductal reabsorption. In the second experiment, the pressure-induced hemihidrotic reflex (contralateral sudomotor enhancement) was revisited, using pressures applied over 10 cm2 areas of the chest (left side: 6 N cm-2) and left heel (3 N cm-2) during both supine and seated postures (N = 12). Participants were passively heated and thermally clamped before pressure application. Hemihidrosis was not observed from the contralateral surfaces within the same (chest) or lower spinal segments (abdomen; both P > 0.05) during chest pressure, but a generalised enhancement followed heel pressure when supine. We suggest that previous observations of hemihidrosis possibly resulted from elevated heat storage, rather than a neural reflex. Chest pressure significantly inhibited ipsilateral sweating (forehead, hand, chest; all P < 0.05), and that influence is hypothesised to result from interactions between ascending mechanoreceptor afferents and the descending sudomotor pathways.

Cutaneous vasomotor adaptation following repeated, isothermal heat exposures: evidence of adaptation specificity.

Unequivocal enhancement of cutaneous vasomotor function has yet to be demonstrated following heat acclimation, possibly because the adaptation stimulus was not sustained, or because thermoeffector function was not assessed at equivalent deep-body temperatures. Therefore, forearm and local cutaneous vascular conductances were evaluated during exercise eliciting matched deep-body temperatures (37.5 °C, 38.5 °C), before and after isothermal heat acclimation. Both indices increased (21% and 25%), confirming cutaneous vasomotor adaptation can occur, provided those experimental design specifications are satisfied.

Multiple Drug-Toxicity Involving Novel Psychoactive Substances, 3-Fluorophenmetrazine and U-47700.

3-Fluorophenmetrazine (3-FPM) is a stimulant-like novel psychoactive substance (NPS) and fluorinated analog of phenmetrazine that has recently appeared on the recreational drug market, with limited published information. Likewise, the synthetic opioid U-47700 has gained popularity among recreational drug users and is frequently detected in postmortem casework. We present the case history, autopsy and toxicological findings of a fatality involving the designer drugs 3-FPM and U-47700 for the first time in the literature. A sensitive and specific liquid chromatography-tandem mass spectrometry method was developed and validated for the quantification of 3-FPM in whole blood, with a 0.001-0.100 mg/L analytical range. The method met the requirements for acceptable linearity, bias and precision. 3-FPM was detected along with U-47700 and other drugs including amitriptyline, nortriptyline, methamphetamine, amphetamine, diazepam, nordiazepam, temazepam, and the designer benzodiazepines flubromazolam and delorazepam. 3-FPM was quantified in the decedent's peripheral (femoral) and central (aortic) blood at 2.4 and 2.6 mg/L, respectively. These concentrations are similar to reported concentrations in non-fatal intoxications. U-47700 was present in peripheral blood at a semi-quantitative concentration of 0.36 mg/L, consistent with reported U-47700 postmortem concentrations. The cause of death was considered multiple drug-toxicity (3-FPM, U-47700, amitriptyline, methamphetamine, diazepam, temazepam, flubromazolam and delorazepam) and the manner of death ruled an accident. This case illustrates the dangers of polysubstance use and discusses the potential overlap between recreational and fatal concentrations for some NPS.

Likely Age-Related Hearing Loss (Presbycusis) in a Stranded Indo-Pacific Humpback Dolphin (Sousa chinensis).

The hearing of a stranded Indo-Pacific humpback dolphin (Sousa chinensis) in Zhuhai, China, was measured. The age of this animal was estimated to be ~40 years. The animal's hearing was measured using a noninvasive auditory evoked potential (AEP) method. The results showed that the high-frequency hearing cutoff frequency of the studied dolphin was ~30-40 kHz lower than that of a conspecific younger individual ~13 year old. The lower high-frequency hearing range in the older dolphin was explained as a likely result of age-related hearing loss (presbycusis).

Thermal and cardiovascular strain imposed by motorcycle protective clothing under Australian summer conditions.

Motorcycle protective clothing can be uncomfortably hot during summer, and this experiment was designed to evaluate the physiological significance of that burden. Twelve males participated in four, 90-min trials (cycling 30 W) across three environments (25, 30, 35 °C [all 40% relative humidity]). Clothing was modified between full and minimal injury protection. Both ensembles were tested at 25 °C, with only the more protective ensemble investigated at 30 and 35 °C. At 35 °C, auditory canal temperature rose at 0.02 °C min(-1) (SD 0.005), deviating from all other trials (p < 0.05). The thresholds for moderate (>38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 min (SD 20.6) and 180 min (SD 33.0), respectively. Profound hyperthermia might eventuate in ~10 h at 30 °C, but should not occur at 25 °C. These outcomes demonstrate a need to enhance the heat dissipation capabilities of motorcycle clothing designed for summer use in hot climates, but without compromising impact protection. Practitioner's Summary: Motorcycle protective clothing can be uncomfortably hot during summer. This experiment was designed to evaluate the physiological significance of this burden across climatic states. In the heat, moderate (>38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 and 180 min, respectively.

A Retrospective Evaluation of Injuries to Australian Urban Firefighters (2003 to 2012): Injury Types, Locations, and Causal Mechanisms.

OBJECTIVE: Benchmark data were sought for evaluating injury trends within Australian firefighters. METHODS: Work-related injury data from Australia's largest urban fire and rescue organization were analyzed (2003 to 2012), with an emphasis on classification (occurrence, mechanism, agency, nature, and location) and demographic details. RESULTS: Firefighters were injured on 6997 occasions (177 injuries per annum per 1000 full-time employees). The largest causal mechanism was muscular stress (74 injuries per 1000 full-time employees annually), with 62.1% of those incidents involving materials handling and slips, trips, and falls. No single mechanism could explain more than 20% of the injuries. The principal injury type involved sprains and strains. The most commonly injured sites were the knee, lower back, shoulder, and ankle. CONCLUSIONS: These observations provide a basis for intervention strategies that target sprains and strains associated with materials handling and slips, trips, and falls.

Thursday drinking and academic load among college women.

OBJECTIVE: Research indicates that alcohol consumption by college students fluctuates across the semester, with consumption changing because of social events and calendar holidays. In addition, some research indicates that Thursday alcohol consumption is a function of Friday course schedule. Students with courses after 10 a.m. or not at all on Friday are more likely to consume alcohol on Thursday nights. Furthermore, college women are increasingly consuming alcohol at higher levels and comprise a larger portion of college students in comparison with their male counterparts. The current study was aimed at examining patterns of Thursday night alcohol consumption and academic load among female college students. METHOD: College students (N = 383, 100% female) participated in a 10-week paper- and web-based survey on alcohol consumption. After completion of the study, academic records of the participants were retrieved for objective measures of academic load. RESULTS: Patterns of Thursday alcohol consumption relate to timing and difficulty of the first course on Friday. However, patterns of Thursday alcohol consumption were not related to other aspects of academic load (e.g., number of academic credits, fall semester grade-point average, cumulative grade-point average, other Friday courses). CONCLUSIONS: It seems that female students who are more likely to consume alcohol on Thursday night have made academic scheduling decisions to allow for this experience. These decisions seem to not adversely affect their grade-point average. Findings suggest that changes to the academic calendar to curb alcohol consumption warrant further investigation.

Possible age-related hearing loss (presbycusis) and corresponding change in echolocation parameters in a stranded Indo-Pacific humpback dolphin.

The hearing and echolocation clicks of a stranded Indo-Pacific humpback dolphin (Sousa chinensis) in Zhuhai, China, were studied. This animal had been repeatedly observed in the wild before it was stranded and its age was estimated to be ~40 years. The animal's hearing was measured using a non-invasive auditory evoked potential (AEP) method. Echolocation clicks produced by the dolphin were recorded when the animal was freely swimming in a 7.5 m (width)×22 m (length)×4.8 m (structural depth) pool with a water depth of ~2.5 m. The hearing and echolocation clicks of the studied dolphin were compared with those of a conspecific younger individual, ~13 years of age. The results suggested that the cut-off frequency of the high-frequency hearing of the studied dolphin was ~30-40 kHz lower than that of the younger individual. The peak and centre frequencies of the clicks produced by the older dolphin were ~16 kHz lower than those of the clicks produced by the younger animal. Considering that the older dolphin was ~40 years old, its lower high-frequency hearing range with lower click peak and centre frequencies could probably be explained by age-related hearing loss (presbycusis).

Evoked-potential audiogram of an Indo-Pacific humpback dolphin (Sousa chinensis).

An evoked-potential audiogram was measured for an Indo-Pacific humpback dolphin (Sousa chinensis) living in the dolphinarium of Nanning Zoo, China. Rhythmic 20 ms pip trains composed of cosine-enveloped 0.25 ms tone pips at a pip rate of 1 kHz were presented as sound stimuli. The dolphin was trained to remain still at the water surface and to wear soft latex suction-cup EEG electrodes used to measure the animal's envelope-following evoked potentials to the sound stimuli. Responses to 1000 rhythmic 20 ms pip trains for each amplitude/frequency combination were averaged and analysed using a fast Fourier transform to obtain an evoked auditory response. The hearing threshold was defined as the zero crossing point of the response input-output function using linear regression. Fourteen frequencies ranging from 5.6 to 152 kHz were studied. The results showed that most of the thresholds were lower than 90 dB re. 1 µPa (r.m.s.), covering a frequency range from 11.2 to 128 kHz, and the lowest threshold of 47 dB was measured at 45 kHz. The audiogram, which is a function of hearing threshold versus stimulus carrier frequency, presented a U-shape with a region of high hearing sensitivity (within 20 dB of the lowest threshold) between approximately 20 and 120 kHz. At frequencies lower than this high-sensitivity region, thresholds increased at a rate of approximately 11 dB octave(-1) up to 93 dB at 5.6 kHz. The thresholds at high frequencies above 108 kHz increased steeply at a rate of 130 dB octave(-1) up to 127 dB at 152 kHz.

Long-term safety and durability of percutaneous septal sinus shortening (The PS(3) System) in an ovine model.

OBJECTIVES: Chronic implants of the PS(3) system were conducted in an ovine model to assess durability and safety at up to 1 year follow-up. BACKGROUND: The long-term durability and safety of emerging percutaneous devices for functional mitral regurgitation remain largely unknown. METHODS: The PS(3) system (consisting of interatrial septal and great cardiac vein devices connected by an adjustable suture bridge) was placed in eight healthy adult sheep. The mitral annular septal-lateral dimension in systole (SLS) was acutely reduced by 15-20%. Animals were sacrificed at up to 12 months postimplant and characterized by intracardiac echocardiography, cardiac computed tomography (CT), and histopathology. In vivo forces exerted on the PS(3) bridge were measured by means of a novel load cell catheter. RESULTS: At 3, 6, and 12 months after implantation, intracardiac echocardiographic and CT showed the PS(3) systems to be intact without erosion and with overall sustained reductions in the SLS. Histopathologic assessment revealed each component correctly deployed in its respective target site without evidence of erosion, thrombus, or device fracture. The SLS was 26.5 +/- 1.7 mm preimplant, 22.0 +/- 1.4 mm post-PS(3) (17.0% reduction), and 22.0 +/- 2.1 mm at latest follow-up. Mean forces exerted on the bridge in vivo ranged from 1.16 N to 1.87 N. CONCLUSIONS: The PS(3) System demonstrated excellent biocompatibility without evidence of erosion, thrombosis, or perforation at up to one-year follow-up in this chronic healthy ovine model. Forces exerted in the PS(3) system were relatively modest and should contribute to the durability of the device.

Articulating the evidence base for effective social work practices: building a database to support a geriatric social work policy agenda.

In an era that demands accountability and cost-effectiveness, health care and social service professionals are increasingly expected to demonstrate the effectiveness of their interventions and treatments. Social workers, specifically those serving the elderly, have been markedly slow in embracing the need to measure outcomes and produce evidence of their practices, which stymies efforts at advocacy and policy development for the profession. Using a modified systematic review method, the New York Academy of Medicine's (NYAM's) Center for Aging Policy created an evidence database comprising peer-reviewed journal articles on social work interventions and outcomes research on cost-effectiveness and other measures of effectiveness. The evidence database, though focused on care of the elderly, draws on research studies involving age groups across the lifespan. A key product of this initiative is a series of white papers on cost-effective interventions in areas such as care management. A work group of social work professionals and a team of NYAM staff with diverse expertise reviewed articles based on their content, key topics, and outcomes. This article describes the steps taken, from the conceptualization of the review process to the development and implementation of the Web-based interface for user access to the evidence database. Though originally conceived as a tool for supporting a policy agenda for the Center for Aging Policy, the evidence database is also a useful reference tool for social workers, policy makers, and others interested in quality of care for elderly.

Contractile and vasorelaxant effects of hydrogen sulfide and its biosynthesis in the human internal mammary artery.

This study aimed to test these hypotheses: cystathionine gamma-lyase (CSE) is expressed in a human artery, it generates hydrogen sulfide (H(2)S), and H(2)S relaxes a human artery. H(2)S is produced endogenously in rat arteries from cysteine by CSE. Endogenously produced H(2)S dilates rat resistance arteries. Although CSE is expressed in rat arteries, its presence in human blood vessels has not been described. In this study, we showed that both CSE mRNA, determined by reverse transcription-polymerase chain reaction, and CSE protein, determined by Western blotting, apparently occur in the human internal mammary artery (internal thoracic artery). Artery homogenates converted cysteine to H(2)S, and the H(2)S production was inhibited by dl-propargylglycine, an inhibitor of CSE. We also showed that H(2)S relaxes phenylephrine-precontracted human internal mammary artery at higher concentrations but produces contraction at low concentrations. The latter contractions are stronger in acetylcholine-prerelaxed arteries, suggesting inhibition of nitric oxide action. The relaxation is partially blocked by glibenclamide, an inhibitor of K(ATP) channels. The present results indicate that CSE protein is expressed in human arteries, that human arteries synthesize H(2)S, and that higher concentrations of H(2)S relax human arteries, in part by opening K(ATP) channels. Low concentrations of H(2)S contract the human internal mammary artery, possibly by reacting with nitric oxide to form an inactive nitrosothiol. The possibility that CSE, and the H(2)S it generates, together play a physiological role in regulating the diameter of arteries in humans, as has been demonstrated in rats, should be considered.

Haplotypes of the beta2-adrenergic receptor gene are associated with essential hypertension in a Singaporean Chinese population.

OBJECTIVE: To investigate the relation between the gene encoding the beta2-adrenergic receptor (B2AR) and essential hypertension in a Singaporean Chinese cohort. METHODS: Three single nucleotide polymorphisms (SNPs) were genotyped in 190 cases and 323 controls, and eight haplotypes were determined and tested for association using the likelihood test statistic. RESULTS: We observed a significant difference in haplotype frequency distributions between the cases and the controls (P <0.00001). A logistic regression model fitted to the data supported this finding. CONCLUSION: The results suggest that variants at the B2AR locus may play a role in the pathophysiology of hypertension in this population.