Inter- and Intra-physician variation in quantifying actinic keratosis skin photodamage.

We investigated the variations in physician evaluation of skin photodamage based on a published photodamage scale. Of interest is the utility of a 10-level scale ranging from none and mild photodamage to actinic keratosis (AK). The dorsal forearms of 55 adult subjects with various amounts of photodamage were considered. Each forearm was independently evaluated by 15 board-certified dermatologists according to the Global Assessment Severity Scale ranging from 0 (less severe) to 9 (the most progressed stage of skin damage). Dermatologists rated the levels of photodamage based upon the photographs in blinded fashion. Results show substantial disagreement amongst the dermatologists on the severity of photodamage. Our results indicate that ratings could be more consistent if using a scale of less levels (5-levels or 3-levels). Ultimately, clinicians can use this knowledge to provide better interpretation of inter-rater evaluations and provide more reliable assessment and frequent monitoring of high-risk populations.

Quantifying skin photodamage with spatial frequency domain imaging: statistical results.

We investigated the change in optical properties and vascular parameters to characterize skin tissue from mild photodamage to actinic keratosis (AK) with comparison to a published photodamage scale. Multi-wavelength spatial frequency domain imaging (SFDI) measurements were performed on the dorsal forearms of 55 adult subjects with various amounts of photodamage. Dermatologists rated the levels of photodamage based upon the photographs in blinded fashion to allow comparison with SFDI data. For characterization of statistical data, we used artificial neural networks. Our results indicate that optical and vascular parameters can be used to quantify photodamage and can discriminate between the stages as low, medium, and high grades, with the best performance of ∼70%, ∼76% and 80% for characterization of low- medium- and high-grade lesions, respectively. Ultimately, clinicians can use this noninvasive approach for risk assessment and frequent monitoring of high-risk populations.

Childhood trauma and sexual behavior in adulthood among internal medicine outpatients.

Abuse in childhood may be associated with a variety of sexual behaviors in adulthood. However, previous studies have been limited by population type, number of traumas inquired about, and number of sexual behaviors explored. In this study, we examined five forms of childhood abuse or trauma (i.e. sexual abuse, physical abuse, emotional abuse, physical neglect, and the witnessing of violence) and 13 sexuality variables (e.g., age at first intercourse, number of different sexual partners) among 76 women in an outpatient resident-provider internal medicine setting. Participants who had experienced childhood "sexual abuse" reported a younger "age at first intercourse" and a greater incidence of having "ever been raped by a stranger" and having "ever been raped by a partner" - but not multiple sexual partners (i.e. promiscuity), as expected. We discuss the implications of these findings.

Borderline personality symptomatology and sexual impulsivity.

OBJECTIVE: According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, borderline personality disorder (BPD) is an Axis II phenomenon that is characterized by impulsivity, including sexual impulsivity. However, little empirical research has been undertaken to confirm and/or define the nature of sexual impulsivity in patients with BPD, which is the focus of the present study. METHOD: Using a cross-sectional approach and sample of convenience, we surveyed 76 women who were being seen as outpatients in an internal medicine clinic regarding: a) borderline personality symptoms using two measures (i.e., the borderline personality scale of the Personality Diagnostic Questionnaire-4, McLean Screening Inventory for Borderline Personality Disorder); and b) their sexual histories. RESULTS: We found two statistically significant differences--those with borderline personality symptomatology were more likely to have an earlier onset of sexual intercourse as well as to report date rape. CONCLUSIONS: Individuals with borderline personality symptomatology report earlier sexual exposure as well as date rape, but not other aspects of sexual impulsivity such a greater number of sexual partners, more frequent treatment for sexually transmitted diseases, etc.

Focal aggregation of voltage-gated, Kv2.1 subunit-containing, potassium channels at synaptic sites in rat spinal motoneurones.

Delayed rectifier K+ currents are involved in the control of alpha-motoneurone excitability, but the precise spatial distribution and organization of the membrane ion channels that contribute to these currents have not been defined. Voltage-activated Kv2.1 channels have properties commensurate with a contribution to delayed rectifier currents and are expressed in neurones throughout the mammalian central nervous system. A specific antibody against Kv2.1 channel subunits was used to determine the surface distribution and clustering of Kv2.1 subunit-containing channels in the cell membrane of alpha-motoneurones and other spinal cord neurones. In alpha-motoneurones, Kv2.1 immunoreactivity (-IR) was abundant in the surface membrane of the soma and large proximal dendrites, and was present also in smaller diameter distal dendrites. Plasma membrane-associated Kv2.1-IR in alpha-motoneurones was distributed in a mosaic of small irregularly shaped, and large disc-like, clusters. However, only small to medium clusters of Kv2.1-IR were observed in spinal interneurones and projection neurones, and some interneurones, including Renshaw cells, lacked demonstrable Kv2.1-IR. In alpha-motoneurones, dual immunostaining procedures revealed that the prominent disc-like domains of Kv2.1-IR are invariably apposed to presynaptic cholinergic C-terminals. Further, Kv2.1-IR colocalizes with immunoreactivity against postsynaptic muscarinic (m2) receptors at these locations. Ultrastructural examination confirmed the postsynaptic localization of Kv2.1-IR at C-terminal synapses, and revealed clusters of Kv2.1-IR at a majority of S-type, presumed excitatory, synapses. Kv2.1-IR in alpha-motoneurones is not directly associated with presumed inhibitory (F-type) synapses, nor is it present in presynaptic structures apposed to the motoneurone. Occasionally, small patches of extrasynaptic Kv2.1-IR labelling were observed in surface membrane apposed by glial processes. Voltage-gated potassium channels responsible for the delayed rectifier current, including Kv2.1, are usually assigned roles in the repolarization of the action potential. However, the strategic localization of Kv2.1 subunit-containing channels at specific postsynaptic sites suggests that this family of voltage-activated K+ channels may have additional roles and/or regulatory components.