Vitamin D Deficiency and Atopic Dermatitis: Consider Disease, Race, and Body Mass.

Vitamin D deficiency causes rickets, but has been associated with various diseases, including atopic dermatitis (AD). This study analyzes serum vitamin D in pediatric medical center patients with AD and potential confounding factors. At Cardinal Glennon Children's Hospital, charts of 665 children with serum 25-hydroxyvitamin D levels taken between 2009 and 2013 were retrospectively reviewed. Defining vitamin D deficiency as <20 ng/mL, neither average 25-hydroxyvitamin D nor deficiency prevalence varied among disease groups, except for cystic fibrosis (CF), which demonstrated significantly higher average vitamin D and lower deficiency prevalence. Children with AD had the lowest prevalence of vitamin D sufficiency, without significant association with disease severity. No seasonal variation was detected. Strong correlations were observed between 25-hydroxyvitamin D levels, body mass index (BMI), and race. Our data showed no strong association between vitamin D levels and AD or AD severity. A strong association was noted between skin type and BMI. The lower prevalence of vitamin D deficiency among children with CF may be explained by lighter skin and lower BMI. A high prevalence of vitamin D insufficiency and deficiency as currently defined among children with dark skin and high BMI suggests a need to reevaluate normal vitamin D levels in these populations.

Cutaneous infection with Mycobacterium fortuitum after subcutaneous injection of human chorionic gonadotropin.

Weight loss clinics are common in the United States.  Unfortunately, some offer dubious weight loss methods such as self-administered human chorionic gonadotropic (HCG) injections. HCG products are unregulated, yet, widely available. Infection is among the risks potentially associated with this treatment.  We report a case of skin infection caused by Mycobacterium fortuitum after HCG injection.

The Wave Flap: A Single-Stage, Modified Nasal Sidewall Rotation Flap for the Repair of Defects Involving the Mid-Alar Groove.

BACKGROUND: Reconstruction of defects straddling the alar groove presents the dual challenges of resurfacing the nasal sidewall and alar subunits while simultaneously recreating the alar groove. The wave flap (WF) is a modified, medially based, nasal sidewall rotation flap that uses locally recruited tissue from the nasal sidewall to facilitate color and texture match and permit camouflage of scars. OBJECTIVE: To detail a surgical repair for defects in the horizontally oriented middle third of the alar groove. MATERIALS AND METHODS: This retrospective case series describes a technique for repair of defects involving the alar groove. Using postoperative photographs, outcomes were assessed by blinded noninvestigator dermatologist raters using the Observer Scar Assessment Scale. RESULTS: Between February 2012 and June 2013, 10 patients were reconstructed using a WF design. Subjective assessment of scar vascularity, pigment, pliability, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 11.1 (out of 50). No complications were noted. CONCLUSION: The WF provides an excellent reconstructive option for Mohs defects of the middle third of the alar groove by recruiting local tissue and permitting maximum scar camouflage. A well-designed and executed WF provides cosmetically exceptional results for defects of the alar groove.

Effect of Solvent on Surface Ordering of Poly(3-hexylthiophene) Thin Films.

Enhancement of charge transport in organic polymer semiconductors is a crucial step in developing optimized devices. A variety of sample preparation conditions, such as film fabrication method, solvent species, and annealing, were found to influence the hole mobility of organic polymers. Despite the fact that many factors can influence their performance, it is believed that polymer surface ordering plays a key role in determining organic polymer function. Here, sum frequency generation (SFG) vibrational spectroscopy was used to nondestructively map the surface/interfacial ordering of poly(3-hexylthiophene) (P3HT) films prepared using different solvents; we believe that solvent interactions determine the degree of surface/interfacial ordering. Both X-ray diffraction (XRD) spectroscopy and scanning electron microscopy (SEM) were used to supplement SFG to systematically study bulk crystallinity and surface morphology. We conclude that SFG is a powerful tool to elucidate the surface/interfacial structural information on polymer semiconducting films. We demonstrate that the solvent composition used to prepare P3HT thin films influences the resulting film surface morphology, surface/interfacial ordering, and bulk crystallinity.

Clinicopathologic evaluation of cardiofaciocutaneous syndrome: overcoming the challenges of diagnosing a rare genodermatosis.

We report the case of a 2-year-old boy from a family with limited financial resources who presented with cutaneous abnormalities, a history of congenital heart defect, and a presumptive diagnosis of Noonan syndrome. Genetic testing had been deferred because of a lack of funds. Skin findings were characteristic of cardiofaciocutaneous syndrome, including keratosis pilaris, ichthyosis, sparse eyebrows, and multiple nevi. A biopsy of a perifollicular thick papule with background hyperpigmentation was obtained to further characterize the cutaneous findings. Clinical evaluation allowed rapid, cost-effective, specific diagnosis in this patient with a RASopathy-spectrum genetic disorder who did not have access to genetic testing. This time-honored clinical approach is adequate for providing information important for prognosis, follow-up, and counseling. We will also discuss available resources for genetic testing and specialized care for patients with RASopathies.

Outcomes analysis of the role of plastic surgery in extremity sarcoma treatment.

Over the past 5 years we have developed a multidisciplinary service for the treatment of extremity sarcoma. This service includes orthopedic oncology, neurosurgery, medical and radiation oncology, and plastic surgery. Prior to 2007, the role of plastic surgery in this multidisciplinary team was limited. After 2007, plastic surgery at our institution played an increasingly integral role in multidisciplinary care. Based on the development of the plastic surgery service at our institution, we were able to evaluate the role of plastic surgery in the outcomes following extremity reconstruction after sarcoma resection. We hypothesize that plastic surgery involvement would reduce the amputation rate without altering recurrence rates. We found a decrease in lower-extremity amputation of approximately 20% without any significant change in recurrence rates. The incidence of infectious complications requiring IV antibiotics decreased by about 20%. The incidence of skin graft loss decreased by 75%. We do report a significant increase in partial flap necrosis. Overall, plastic surgery is an essential component of the multidisciplinary team in the care of extremity sarcoma.

Chain-growth polymerization of aryl Grignards initiated by a stabilized NHC-Pd precatalyst.

An N-heterocyclic carbene-ligated palladium catalyst was discovered to mediate living, chain-growth polymerizations of both phenylene- and thiophene-based monomers. Polymerization of a fluorene-based monomer, on the other hand, did not proceed through a living, chain-growth pathway. Excitingly, block copolymerizations of phenylene and thiophene proceeded via a chain-growth pathway, regardless of the order of monomer addition. Although some chain termination was observed during these copolymerizations, this pathway could be minimized when the second monomer was added shortly after consumption of the first monomer. These results suggest that the catalyst resting-state at the end of polymerization is unstable. As a result, modifications to the NHC-scaffold or the 3-chloropyridine ligand will be necessary to generate an improved catalyst.

Limitations of Using Small Molecules to Identify Catalyst-Transfer Polycondensation Reactions.

Catalyst-transfer polycondensation (CTP) is a relatively new method for synthesizing conjugated polymers in a chain-growth fashion using transition metal catalysis. Recent research has focused on screening catalysts to broaden the monomer scope. In this effort, small molecule reactions have played an important role. Specifically, when selective difunctionalization occurs, even with limiting quantities of reaction partner, it suggests an associative intermediate similar to CTP. Several new chain-growth polymerizations have been discovered using this approach. We report herein an attempt to use this method to develop chain-growth conditions for synthesizing poly(2,5-bis(hexyloxy)phenylene ethynylene) via Sonogashira cross-coupling. Hundreds of small molecule experiments were performed and selective difunctionalization was observed with a Buchwald-type precatalyst. Unexpectedly, these same reaction conditions led to a step-growth polymerization. Further investigation revealed that the product ratios in the small molecule reactions were dictated by reactivity differences rather than an associative intermediate. The lessons learned from these studies have broad implications on other small molecule reactions being used to identify new catalysts for CTP.

Electronic Biosensors Based on III-Nitride Semiconductors.

We review recent advances of AlGaN/GaN high-electron-mobility transistor (HEMT)-based electronic biosensors. We discuss properties and fabrication of III-nitride-based biosensors. Because of their superior biocompatibility and aqueous stability, GaN-based devices are ready to be implemented as next-generation biosensors. We review surface properties, cleaning, and passivation as well as different pathways toward functionalization, and critically analyze III-nitride-based biosensors demonstrated in the literature, including those detecting DNA, bacteria, cancer antibodies, and toxins. We also discuss the high potential of these biosensors for monitoring living cardiac, fibroblast, and nerve cells. Finally, we report on current developments of covalent chemical functionalization of III-nitride devices. Our review concludes with a short outlook on future challenges and projected implementation directions of GaN-based HEMT biosensors.