Disparities in nonmelanoma skin cancer in Hispanic/Latino patients based on Mohs micrographic surgery defect size: A multicenter retrospective study.

BACKGROUND: There is limited literature regarding potential disparities in nonmelanoma skin cancer for patients with skin of color. OBJECTIVE: Use the sizes of Mohs micrographic surgery defects to examine disparities in nonmelanoma skin cancer among Hispanic/Latino patients with a secondary aim to examine the effect of insurance type. METHODS: We conducted a multicenter retrospective study using data from 3 major institutions in Los Angeles County. A total of 3486 Mohs micrographic surgeries of basal cell, squamous cell, and basosquamous cell carcinomas were analyzed. RESULTS: Mohs micrographic surgery defect sizes were 17% larger among Hispanic/Latino patients compared with non-Hispanic White patients. More notably, when comparing defect sizes of squamous cell carcinomas to those of basal cell carcinomas, defects were 80% larger among Hispanic/Latino patients compared to non-Hispanic White patients who had 25% larger defect sizes. Compared to patients with Medicare, patients with health maintenance organization and Medicaid/health maintenance organization had 22% and 52% larger defect sizes, respectively, whereas patients with preferred provider organization, had 10% smaller defect sizes. LIMITATIONS: The data included were from a single county population. CONCLUSION: Disparities regarding nonmelanoma skin cancer exist between patients with skin of color and White patients. Patients and the medical community need to be cognizant that skin cancer can develop in patients regardless of their race and ethnicity.

Detection of viral gene expression in risk-stratified biopsies reveals no active HPV in cutaneous squamous cell carcinoma.

BACKGROUND: Human papillomavirus (HPV) infection is known to promote the development of mucosal squamous cell carcinoma (mSCC), including pathologically high-grade lesions, but its role in cutaneous squamous cell carcinoma (cuSCC) remains unclear, particularly in lesions that are considered high risk. OBJECTIVE: We aimed to determine whether enhanced HPV transcriptional activity can be detected in high-risk cuSCC samples compared with low-grade SCC samples or normal skin. METHODS: We performed RNA sequencing of cuSCC across 23 risk-stratified skin lesions. A subset of samples was tested for the presence of HPV DNA. High-quality, non-human reads from each sample group were used for viral analysis using Microbiome Coverage Profiler. RESULTS: None of the samples analysed had detectable expression of HPV RNA, while 64% of samples tested positive for HPV DNA. All samples were found to have expression of human endogenous retrovirus, and multiple samples showed expression of other viruses. CONCLUSIONS: Viral and prophage gene expression can be monitored in cuSCC or normal skin biopsies, yet no sample in our study showed evidence of active HPV gene expression despite evidence of HPV genome presence. This suggests HPV transcription does not play a role in differentiating high-risk cuSCCs from low-risk cuSCCs or normal skin.

Voriconazole increases the risk for cutaneous squamous cell carcinoma after lung transplantation.

Lung transplant recipients (LTR) are at high risk of cutaneous squamous cell carcinoma (SCC). Voriconazole exposure after lung transplant has recently been reported as a risk factor for SCC. We sought to study the relationship between fungal prophylaxis with voriconazole and the risk of SCC in sequential cohorts from a single center. We evaluated 400 adult LTR at UCLA between 7/1/2005 and 12/22/2012. On 7/1/2009, our center instituted a protocol switch from targeted to universal antifungal prophylaxis for at least 6 months post-transplant. Using Cox proportional hazards models, time to SCC was compared between targeted (N = 199) and universal (N = 201) prophylaxis cohorts. Cox models were also used to assess SCC risk as a function of time-dependent cumulative exposure to voriconazole and other antifungal agents. The risk of SCC was greater in the universal prophylaxis cohort (HR 2.02, P < 0.01). Voriconazole exposure was greater in the universal prophylaxis cohort, and the cumulative exposure to voriconazole was associated with SCC (HR 1.75, P < 0.01), even after adjustment for other important SCC risk factors. Voriconazole did not increase the risk of advanced tumors. Exposure to other antifungal agents was not associated with SCC. Voriconazole should be used cautiously in this population.

Furuncular myiasis in 2 American travelers returning from Senegal.

Furuncular myiasis caused by Cordylobia anthropophaga larvae is commonly seen in Africa but rarely is diagnosed in travelers returning from the sub-Saharan region. We report 2 cases of furuncular myiasis due to Cordylobia species in adolescent American travelers returning from Senegal.

Implication of potassium on the quality of cherry tomato fruits after postharvest during cold storage.

The influence of the potassium (K) content in tomato fruits over compounds or antioxidant characteristics during the postharvest period in cold storage is little known. The aim of this work was to determine whether the effect of a biofortification programme with K in KCl form can improve the postharvest storage of cherry tomato fruits at 4 °C. K treatments applied during the crop cycle of the plants: 5, 10 and 15 mM of KCl. Biomass parameters, levels of K, antioxidant capacity test, Vitamin C, carotenoids, phenolic compounds and free polyamines in tomato cherry fruits were measured. Our results show that the treatment with 15 mM KCl prevents weight and water loss during postharvest storage at 4 °C, increases K concentration, and bolsters the antioxidant capacity, since the concentration in lycopenes as well as flavonoids and derivatives rose, while the contents in Vitamin C together with hydroxycinnamic acids and derivatives remained stable.

Effects of climatic control on tomato yield and nutritional quality in Mediterranean screenhouse.

BACKGROUND: The quality of vegetables for fresh consumption is a complex issue. In this study the yield and quality of cherry tomato fruits were assessed under different environmental control conditions, namely in a screenhouse (S), in a screenhouse equipped with a fogging system (SF) and in a screenhouse with complements such as plastic sheeting to maintain the microclimate created by the fogging system (SFS), as well as under open field (OF) cultivation. Levels of vitamin C, carotenoids (lycopene, ß-carotene and lutein), phenolic compounds (flavonoids and phenolic acids), sugars (fructose, glucose and sucrose), organic acids (citric acid and malic acid) and flavour indices were measured. The aim of the study was to determine how different environmental control technologies could influence production and quality traits in tomato cherry fruits cultivated in a Mediterranean area. RESULTS: The results showed that the fogging system treatment's decline in maximum vapour pressure deficit (by 0.7 kPa compared with OF cultivation), increase in mean fruit weight (by about 4 g per fruit) and low radiation and temperature values may exert a positive effect on lycopene accumulation. CONCLUSION: For the production and nutritional parameters measured, it is postulated that the fogging system treatment offers a better balance between production and nutritional quality. This treatment proved to be best in terms of productivity, vitamin C and lycopene contents and antioxidant capacity.

Topological properties of large-scale structural brain networks in children with familial risk for reading difficulties.

Developmental dyslexia is a neurobiological deficit characterized by persistent difficulty in learning to read in children and adults who otherwise possess normal intelligence. Functional and structural connectivity data suggest that developmental dyslexia could be a disconnection syndrome. However, whether abnormalities in connectivity exist in beginning readers at-risk for reading difficulties is unknown. Using graph-theoretical analysis, we investigated differences in global and regional topological properties of structural brain networks in 42 beginning readers with (FH+) and without (FH-) familial risk for reading difficulties. We constructed separate structural correlation networks based on measures of surface area and cortical thickness. Results revealed changes in topological properties in brain regions known to be abnormal in dyslexia (left supramarginal gyrus, left inferior frontal gyrus) in the FH+ group mainly in the network constructed from measures of cortical surface area. We also found alterations in topological properties in regions that are not often advertised as dyslexia but nonetheless play important role in reading (left posterior cingulate, hippocampus, and left precentral gyrus). To our knowledge, this is the first report of altered topological properties of structural correlation networks in children at risk for reading difficulty, and motivates future studies that examine the mechanisms underlying how these brain networks may mediate the influences of family history on reading outcome.

The effect of environmental conditions on nutritional quality of cherry tomato fruits: evaluation of two experimental Mediterranean greenhouses.

BACKGROUND: The aim of this study was to examine how different environmental factors (temperature, solar radiation, and vapour-pressure deficit [VPD]) influenced nutritional quality and flavour of cherry tomato fruits (Solanum lycopersicum L. cv. Naomi) grown in two types of experimental Mediterranean greenhouses: parral (low technology) and multispan (high technology). RESULTS: Fruits were sampled three times during 3 years (2004, 2005 and 2006): at the beginning, middle and end of the fruit production period. Values for temperature, solar radiation, and VPD peaked in the third sampling in both greenhouses; values were higher in the parral-type greenhouse, triggering abiotic stress. This stress reduced the accumulation of lycopene and essential elements, augmenting the phytonutrient content and the antioxidant capacity of tomatoes. During the third sampling, sugars were increased while organic acid content diminished, producing tomatoes with a sweeter-milder flavour. The parral greenhouse produced tomatoes with higher phenolic compounds and ascorbic acid contents, together with a greater antioxidant capacity, without showing differences in flavour parameters. CONCLUSION: The higher phytonutrients content and antioxidant activity during the environmental stress, more pronounced in parral than multispan greenhouse, together with the sweeter-milder flavour, conferred a notable nutritional benefit, which considerably improved the nutritional and organoleptic quality of these tomatoes.

Potential inoculum sources of Fusarium species involved in asparagus decline syndrome and evaluation of soil disinfestation methods by qPCR protocols.

BACKGROUND: Asparagus decline syndrome (ADS), one of the most important diseases affecting asparagus crops, causes important yield losses worldwide. Fusarium proliferatum, F. oxysporum and F. redolens are among the main species associated with ADS. To explore their potential inoculum sources and the effectiveness of soil disinfestation practices for ADS management, molecular methods based on a quantitative real-time polymerase chain reaction (qPCR) were developed. qPCR-based molecular tools demonstrated advantages in the sensitive and specific detection and quantification of fungal pathogens in comparison with less-accurate and time-consuming traditional culture methods. RESULTS: F. proliferatum, F. oxysporum and F. redolens could be specifically detected and accurately quantified in asparagus plants, soil and irrigation water collected from asparagus fields with ADS symptoms by means of the designed TaqMan qPCR protocols. Furthermore, these molecular tools were successfully applied for evaluation of the efficacy of diverse soil disinfestation treatments. Chemical fumigation with dazomet and biosolarization with pellets of Brassica carinata contributed to a significant reduction in the inoculum densities of the three Fusarium species in treated soils, which was correlated with production increases. CONCLUSIONS: The capability to accurately detect and quantify the main Fusarium species involved in ADS in plants, soil and water samples by means of qPCR will allow identification of high-risk fields that can be avoided or managed to reduce yield losses. Quantification of pathogen densities in the soil may also provide essential insights into the effectiveness of soil disinfestation methods for ADS management. © 2021 Society of Chemical Industry.

Where is it? The utility of biopsy-site photography.

BACKGROUND: With wrong-site surgery being one of the major causes of medical lawsuits in the United States, tools to confirm location are essential. A previous survey of 300 Mohs surgeons revealed that 14% of malpractice cases were due to wrong-site surgery. In dermatologic surgery, photography is helpful in precisely locating biopsy sites. OBJECTIVES: We present a case series of 34 biopsy-proven cutaneous head and neck malignancies performed in our university-based dermatology clinic, comparing the reliability of patient and blinded dermatologist identification with that of biopsy-site photography. RESULTS: Of 34 biopsy sites, the patient and the blinded dermatologist incorrectly identified four (12%). The patient alone incorrectly identified an additional six biopsy sites, resulting in a total of 10 (29%) cases incorrectly identified by the patient. There were no instances in which the patient correctly identified the biopsy site and the blinded dermatologist incorrectly identified it. CONCLUSION: In our current medical environment, in which more than 90% of health care is delivered in a clinic setting, wrong-site surgery is certainly underreported. In adopting a zero-tolerance policy for wrong-site surgeries, biopsy-site photography saves time, money, and potential frustration, hopefully eliminating the number of excisions performed on the wrong site.

Stability of Cocaine Compounds in Biological Fluids During Post-Analytical Sample Storage.

The objective of this study is to evaluate in vitro stability of cocaine compounds, cocaine (COC), benzoylecgonine (BE), ecgonine methyl ester (EME) and benzoylecgonine ethyl ester (EBE), in blood and urine, during post-analysis custody. Stability was evaluated by measuring percent recovery. Parameters evaluated were time of custody (1 year), storage temperature (-20°C and 4°C), influence of preservative (only for blood samples) and pH (only for urine samples). The impact of the temperature is very important in blood samples. At -20°C all compounds demonstrated to be stable, with recoveries higher than 80% after 1 year. In contrast, degradation was observed in the concentration for all four compounds when the samples were maintained at 4°C. In these same conditions, the influence of the preservative was also noticeable and a higher stability was found in samples preserved with NaF. COC and EBE had similar profiles, and both compounds disappeared after 30 days in samples without NaF and after 150 days in samples with NaF added. EME disappeared after 185 days and after 215 days in samples without and with preservative, respectively. BE recoveries, after 365 days of storage, were 68.5% (in samples with NaF) and 3.7% (in samples without NaF). In urine samples, the four compounds were stable in all the studied conditions except when samples were at pH 8 and stored at 4°C where the compounds disappeared (COC and EBE after 75 days of storage and EME after 15 days). The exception was BE, with a recovery of 23% after 1 year of storage. Of the temperatures evaluated, -20°C seems to be optimal for storage to maintain the stability of cocaine and metabolites in biological samples. This can be further enhanced by maintaining a pH of 4 in urine samples and adding a NaF preservative to blood.

[Recommendations for clinical practice in diabetes and obesity. The Madrid Agreements. Document agreed by the working groups of the scientific societies: SENDIMAD, SOMAMFYC, SEMG Madrid, SEMERGEN Madrid and RedGDPS]. / Recomendaciones para la práctica clínica en diabetes y obesidad. Los acuerdos de Madrid. Documento consensuado por los grupos de trabajo de las sociedades científicas: SENDIMAD, SOMAMFYC, SEMG Madrid, SEMERGEN Madrid y RedGDPS.

The increase in the prevalence of type 2 diabetes and the worldwide expansion of overweight and obesity are intrinsically linked. The percentage of diabetes attributable to weight gain amounts to more than 80% in many countries. This relationship is addressed in a Spanish Consensus Document from SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN and SEMFYC published in 2015 and which gathers best available evidences. Based on the statements of this consensus document, we propose five recommendations for clinical practice to establish a diagnosis of precision and the most appropriate treatment for joint diabetes and obesity. These recommendations have been agreed by the SENDIMAD, SOMAMFYC, SEMG Madrid and RedGDPS Working Groups: 1. For every patient with diabetes and obesity, in addition to the calculation of the body mass index, the percentage of body fat and the approximation to the assessment of body composition should be evaluated throughout the whole process (both at the beginning and follow up). 2. The approximation to the degree and distribution of body fat requires the measurement and recording of the waist circumference of these patients. 3. The integrated assessment of the patient with type 2 diabetes-obesity requires the evaluation of the degree of physical activity and/or characterization of the sedentary condition. 4. The prescription of lifestyle changes should be incorporated into therapeutic education (individualized, flexible, autonomous and sustainable diet and physical activity plan. 5. The pharmacological approach in the treatment of type 2 diabetes-obesity implies the choice of anti-diabetic drugs that facilitate the loss of fat.

El aumento en la prevalencia de diabetes tipo 2 y la expansión a nivel mundial de los estados de sobrepeso y obesidad están intrínsecamente vinculados, de forma que el porcentaje de diabetes atribuible al aumento de peso llega a ser superior al 80% en muchos países. En 2015 se publica un Documento de Consenso español de SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC que aborda esta doble condición de acuerdo con las mejores evidencias. Desde las afirmaciones de dicho consenso proponemos cinco recomendaciones para la práctica clínica consensuadas por los Grupos de trabajo de SENDIMAD, SOMAMFYC, SEMG Madrid y RedGDPS, con el fin de establecer un diagnóstico de precisión y el tratamiento más adecuado:1. En todo paciente con diabetes y obesidad debe abordarse, tanto al inicio como en el seguimiento, además del cálculo del índice de masa corporal (IMC), el porcentaje de grasa corporal y la valoración de la composición corporal.2. La aproximación al grado y distribución de la grasa corporal requiere incluir la medición y registro del perímetro de cintura de estos pacientes.3. La valoración integral del paciente con diabetes tipo 2-obesidad exige la evaluación del grado de actividad física y/o caracterizar la condición de sedentarismo.4. La prescripción de cambios del estilo de vida debe ser incorporada a la educación terapéutica (plan dietético y de actividad física individualizado, flexible, autónomo y sostenible).5. El abordaje farmacológico en el tratamiento de la diabetes-obesidad implica la elección de fármacos antidiabéticos que faciliten la pérdida de grasa.

Adult-onset tufted angioma: a case report and review of the literature.

Tufted angiomas (TAs) are benign vascular tumors, primarily occurring on the trunk and extremities of children younger than 5 years. Few cases occurring on the oral mucosa and in adults have been reported. Although they are typically isolated lesions, TA has been associated with port-wine stains. We describe a case of adult-onset TA on the lower lip mucosa.

Syringomatous carcinoma in a young patient treated with Mohs micrographic surgery.

Syringomatous carcinoma (SC) has typically been observed in middle-aged and older patients. We report a case of SC mimicking an epidermoid cyst in a 23-year-old Asian man. Histopathologic examination results showed a dermal neoplasm consisting of nests of basaloid cells, focal areas of ductal differentiation, moderate dermal fibrosis, and moderate nuclear atypia consistent with a diagnosis of SC. No perineural involvement was noted. Results of 2005. immunohistochemical analysis revealed positivity for high- and low-molecular-weight cytokeratins, as well as for carcinoembryonic antigen (CEA). There was scattered immunoreactivity to S-100 protein. The tumor was completely excised Pennsylvania. using Mohs micrographic surgery (MS). This case demonstrates the importance of differentiating SC from other benign or malignant entities, the value of a prompt diagnosis of SC, and the effective treatment of SC with MMS.

Palisaded encapsulated neuroma--a classic presentation of a commonly misdiagnosed neural tumor.

We present a case report of a classical presentation of palisaded encapsulated neuroma (PEN) of the skin occurring on the nasolabial crease and a review of the literature. A young woman presented with a smooth lobulated papule on the cheek enlarging over 2 years. Histologic examination revealed a well-circumscribed dermal nodule of small spindle cells with wavy nuclei arranged in fascicles, consistent with the diagnosis of PEN. PEN is a previously described, benign cutaneous neural tumour, with a histological appearance between that of a neurofibroma and a schwannoma. Though not uncommon, PEN remains under-diagnosed by many pathologists. Clinically, PEN is most commonly misdiagnosed as a basal cell carcinoma, a nevus, or as a neurofibroma.

Topical tacrolimus therapy for vitiligo: therapeutic responses and skin messenger RNA expression of proinflammatory cytokines.

BACKGROUND: Previous studies have documented humoral and cell-mediated immunologic defects in patients with vitiligo. OBJECTIVE: This 24-week study assessed the efficacy and safety of tacrolimus 0.1% ointment in patients with generalized vitiligo as well as the pretreatment and post-treatment expression of cytokines in the depigmented and normal skin of patients compared with controls. METHODS: Twenty-three patients were enrolled in this investigation, and 19 patients completed the study; 8 were male and 11 were female. Fifteen age-, race-, and sex-matched control subjects were also included. Patients were treated with tacrolimus 0.1% ointment applied twice daily. Repeat evaluations were performed at 4, 8, 12, 16, 20, and 24 weeks. Three-millimeter punch biopsy specimens were taken from the depigmented, non-sun-exposed skin and adjacent normal skin of patients at baseline and 24 weeks, and from normal, non-sun-exposed skin of controls. Cellular messenger RNA expression for interleukin 2 (IL-2), IL-4, IL-10, tumor necrosis factor alfa (TFN-alpha), and interferon gamma (IFN-gamma) were determined by real-time quantitative polymerase chain reaction. RESULTS: At 24 weeks, 17 of 19 patients (89%) achieved varying levels of repigmentation. There was a statistically significant decrease in overall disease severity scores at 24 weeks. Thirteen patients (68%) had greater than 75% repigmentation of face and/or neck lesions. Signs and symptoms of irritation were minimal. At baseline, compared with healthy controls, vitiligo patients demonstrated a statistically significant increase in the expression of IFN-gamma in involved and adjacent uninvolved skin (P=.05 and P=.02, respectively); significantly increased TNF-alpha expression in involved and uninvolved skin (P=.01 and P=0.02, respectively); and significantly increased IL-10 expression in involved and uninvolved skin (P=.01 and P=.04, respectively). Posttreatment, TNF-alpha expression decreased in the depigmented and adjacent uninvolved skin (P <.001). There was no statistically significant change in IL-10 or IFN-gamma posttreatment. These data suggest that tacrolimus 0.1% ointment is a safe and effective therapy for patients with vitiligo. It further suggests that an imbalance in local cytokine expression may play a role in the pathogenesis of vitiligo. Suppression of TNF-alpha after topical tacrolimus application may be associated with repigmentation of vitiligo.

Regression of cutaneous intravascular lymphoma with rituximab.

Intravascular lymphoma, also known as malignant angioendotheliomatosis or angiotropic lymphoma, is a rare non-Hodgkin lymphoma that is usually fatal. It often presents with cutaneous and/or nervous system involvement, but the disease can involve any organ system. Clinical symptoms result from the occlusion of small vessels by tumor cells and fibrin. We present a case of cutaneous intravascular lymphoma successfully treated with rituximab, a recombinant antibody to CD20 antigen found on B lymphocytes.