Basal cell carcinoma arising from a nonhealing lower extremity ulcer: a case report.

INTRODUCTION: BCC is a malignancy that arises from the basal cells of the epidermis. Despite being the most common cancer worldwide, it rarely occurs in the setting of long-standing ulceration. Malignant transformation of wounds and scars is typically associated with the development of SCC, as with an MU. Reports in the literature of BCC arising within nonhealing, lower extremity wounds are limited. CASE REPORT: The authors report a case of a 65-year-old man with several comorbidities who presented to the clinic with a nonhealing wound on the right lateral ankle. The wound first began as warts during childhood that had necessitated frequent debridement. The lesions persisted and, 7 years ago, developed into an ulcer with a large fungating mass associated with pain, bleeding, and foul-smelling exudate. Biopsy findings were consistent with infiltrative-type BCC. He was not a surgical candidate given his comorbidities and was instead treated with radiation therapy. No evidence of metastasis was seen on follow-up imaging. CONCLUSION: This case highlights the importance of prompt biopsy and cultures in patients with suspicious ulcers and wounds that do not respond to appropriate treatment.

Human-Centric Digital Twins in Industry: A Comprehensive Review of Enabling Technologies and Implementation Strategies.

The last decade saw the emergence of highly autonomous, flexible, re-configurable Cyber-Physical Systems. Research in this domain has been enhanced by the use of high-fidelity simulations, including Digital Twins, which are virtual representations connected to real assets. Digital Twins have been used for process supervision, prediction, or interaction with physical assets. Interaction with Digital Twins is enhanced by Virtual Reality and Augmented Reality, and Industry 5.0-focused research is evolving with the involvement of the human aspect in Digital Twins. This paper aims to review recent research on Human-Centric Digital Twins (HCDTs) and their enabling technologies. A systematic literature review is performed using the VOSviewer keyword mapping technique. Current technologies such as motion sensors, biological sensors, computational intelligence, simulation, and visualization tools are studied for the development of HCDTs in promising application areas. Domain-specific frameworks and guidelines are formed for different HCDT applications that highlight the workflow and desired outcomes, such as the training of AI models, the optimization of ergonomics, the security policy, task allocation, etc. A guideline and comparative analysis for the effective development of HCDTs are created based on the criteria of Machine Learning requirements, sensors, interfaces, and Human Digital Twin inputs.

Squamous Cell Carcinoma With Unusual Benign-Appearing Cystic Features on Histology.

Squamous cell carcinoma (SCC) is a malignancy that arises from keratinocytes of the epidermis. Cystic variants of several types of cutaneous neoplasms have been rarely described in the literature. We report a case of biopsy-proven, well-differentiated invasive SCC treated with Mohs surgery. On frozen sections, the pathology slides showed benign-appearing cystic structures in the margins that persisted after it had appeared that the original malignancy had been cleared. After taking another Mohs stage due to clinical suspicion, additional SCC was found and was subsequently cleared after two more Mohs stages. To the best of our knowledge, this is the first report to histologically demonstrate biopsy-proven invasive SCC with benign-appearing cystic structures on frozen sections.

Effect of core muscle strengthening on throwing velocity in cricket players in Pakistan: a 6-week randomized controlled trial.

BACKGROUND: During fielding throwing ball with more velocity and accuracy towards the stump to reduce score and produce an out of the opponent team. Core is the power house of the body. Core training improves the strength of trunk muscles and allows the players to kick, throw, pull, and push with greater force. This study was conducted to determine the effects of core muscle strengthening on throwing velocity in cricket players that whether core muscle strengthening would help the cricket players to improve their throwing velocity and core endurance. METHODS: A 6 weeks' randomized controlled trial in which Ninety-eight male cricket players participated and divided into strength training (interventional) and non-strength training (control group). Interventional group followed general core strengthening exercise protocol for six weeks for 3 days a week. Assessment of the players include core assessment test (back extension, supine forward flexion test, prone bridge test). Time and throwing velocity were noted by stop watch and radar gun in km/hr respectively at baseline and after 6 weeks of core training. Control group did not follow any exercise program but continued their usual cricket training. RESULTS: Mean age of interventional group was 20.4±4.9 years and control group was 21.6±3.4 years. The mean BMI of interventional and control group was 22.4±2.7 kg/m2 and 21.8±2.1 kg/m2, respectively. Comparing both groups, in between group analysis strength training group results showed statistically highly significant increase P<0.001 in components throwing velocity, back extension, supine flesion, right plank lateral, left lateral plane and isometric prone plank than non-strengthening group. In within group analysis, strength group had improved as compared to the control group which showed no improvement. CONCLUSIONS: There is significant increase in throwing velocity and core endurance with six weeks general core strengthening in male cricket players.

A Case of Lichen Planus Masquerading as Guttate Psoriasis.

Lichen planus (LP) is a chronic inflammatory disease that affects the skin, hair, nails, and mucous membranes, with variants such as drug-induced lichen planus, which is triggered by medications such as angiotensin-converting enzyme (ACE) inhibitors and antimalarials. Guttate psoriasis (GP), a clinical variant of psoriasis, is associated with streptococcal infections and presents with drop-like papules on the trunk and proximal extremities. In this report, we present a case of LP in an atypical location masquerading as GP and the importance of prompt dermatological referral to improve the patient's quality of life. Coexistence and similarities between several variants of LP and plaque psoriasis have been seen in the literature. However, to our knowledge, our report is the first to show LP specifically mimicking GP.

Ulcerated zosteriform nodules in adenocarcinoma of the colon.

Histiocytoid Sweet's syndrome (HSS) is a rare variant of Sweet's syndrome that typically has similar clinical findings to the classic variant but is diagnosed after histologic review. It is characterized by a dermal infiltrate composed of immature, nonblastic myeloid cells with a histiocytic appearance. In this report, we present a case of a 56-year-old Hispanic man with history of stage IIIB adenocarcinoma of the colon who presented with a case of HSS that mimicked a zosteriform cutaneous metastasis. Several types of cancers can metastasize to the skin, leading to varying cutaneous presentations. In particular, a zosteriform dermatomal distribution of cutaneous metastasis is common in melanoma and has been reported in other cancers, such as colon and breast. To our knowledge, this is the first case in which the clinical presentation of HSS appeared in a zosteriform pattern and distribution.

Ophiasis alopecia areata treated with microneedling.

Alopecia areata (AA) is a T cell-mediated autoimmune disease resulting in the destruction of hair follicles. Ophiasis refers to a subtype of AA that presents as a symmetric, band-like hair loss pattern of the occipital, temporal, and parietal regions of the scalp. We present a case of a 58-year-old white man with AA, ophiasis pattern, who was treated with clobetasol 0.05% solution and four treatments of microneedling with triamcinolone over 6 months. He underwent gradual improvement, most notably on his left occipital scalp where his hair loss was most prominent, with near complete hair regrowth on his left occipital scalp. Microneedling with triamcinolone can be considered as a promising treatment in cases of ophiasis AA.

Allergic contact dermatitis of adjacent normal skin from 5-fluorouracil for the treatment of flat facial warts.

Topical 5-fluorouracil has proven to be an effective treatment for flat warts. Although cases of local irritation at the site of application have been reported, allergic contact dermatitis on the adjacent normal skin is generally uncommon. Reactions to propylene glycol and stearyl alcohol, two vehicle components of 5-fluorouracil, have also been described. In this report, we present a 21-year-old woman who developed allergic contact dermatitis of the adjacent normal skin after topical application of 5-fluorouracil to the face for the treatment of flat warts.

Scientometric Analysis: University Hospital Versus University College of Medicine.

Many medical specialties use scientometrics to assess the impact of publications, journals, and authors. The aim of this study was to analyze and compare trends of publications from a hospital medical center to publications from a college of medicine connected to that hospital and compare collaboration rates between them to other domestic and international institutions. We used Elsevier's SCOPUS database to compare Penn State College of Medicine (PSCOM) publications to Hershey Medical Center (HMC) publications, analyzing 31,856 total publications. We hypothesized that HMC and PSCOM have room to improve on both internal and international collaborations. Our results show that despite PSCOM's international collaboration being nearly three times higher than HMC, overall international collaboration is less than 2%, far below the US national average.

Leg ulceration with histological features of pseudoxanthoma elasticum.

Pseudoxanthoma elasticum (PXE) is an inherited connective tissue disorder with extensive degeneration and calcification of elastic tissue. Histology demonstrates calcified elastic fibers in the mid to lower dermis with a characteristic "steel wool" appearance. A limited number of published cases have described various inflammatory skin diseases presenting with PXE-like histology without clinical manifestations of PXE. Several other conditions associated with abnormal calcium metabolism have also been documented, in which coincidental histological features of PXE have been observed in patients without clinical findings. We present a case of ulceration and lipodermatosclerosis in the setting of venous insufficiency alongside histological features of PXE.

Paraneoplastic eczematous eruption associated with Hodgkin's lymphoma.

Hodgkin's disease (HD) is a common malignant lymphoma that classically presents with painless lymphadenopathy, weight loss, nocturnal sweats, fever, and generalized pruritus. Unlike other lymphoproliferative disorders, cutaneous involvement is uncommon with HD. Diffuse hyperpigmentation, prurigo nodularis, acquired ichthyosis, erythema nodosum, mycosis fungoides, herpes zoster, and vasculitis have all been described as nonspecific or paraneoplastic manifestations of HD. A small set of cases of adult new-onset recalcitrant eczema has recently been described as a nonspecific cutaneous manifestation of HD. In agreement with these reports, we present a case of a 28-year-old woman who initially presented with persistent lymphadenopathy and a pruritic eczematous dermatitis that preceded the diagnosis of HD.

Botulinum Toxin in the Long-Term Treatment of Refractory Raynaud's Phenomenon

Raynaud's phenomenon is an exaggerated physiological response of blood vessels in the distal extremities to emotional stress and cold. It can be idiopathic or secondary to a connective tissue disorder, such as scleroderma or systemic lupus erythematosus. Treatment for Raynaud's phenomenon consists primarily of lifestyle modifications; if unsuccessful, pharmacotherapy with dihydropyridine calcium channel blockers can be added. Botulinum toxin (BTX-A) is a neurotoxic protein produced by Clostridium botulinum spores. While most widely known for its cosmetic use, BTX-A has many therapeutic utilities due to its ability to inhibit multiple neurotransmitters. In this report, we present a patient with Raynaud's phenomenon refractory to standard therapies whose symptoms resolved after treatment with BTX-A. Follow-up with the patient after one and five years showed no relapse or recurrence of symptoms. J Drugs Dermatol. 2019;18(9):943-945.