Novel modification of Marcy operation for indirect inguinal hernia reconstituting deep inguinal ring shutter action.

PURPOSE: The two most frequent and significant complications after inguinal hernia repair are hernia recurrence and post-herniorrhaphy chronic pain. To add anatomic and physiologic strength to the tissue repair, especially in indirect inguinal herniorrhaphy, we devised a modification of Marcy operation that can reconstitute inguinal shutter action more efficiently by changing the direction of the sutures vertical to horizontal. METHODS: During 36 months from 1st Jan. 2019, 148cases of 140 patients were operated for Indirect inguinal hernia or Pantaloon hernia (11 cases). 145 indirect inguinal herniorrhaphy were performed exclusively with author's modification of Marcy operation. Hernia recurrence during the follow-up period (3 months-36 months), and postoperative chronic pain at 3 months after herniorrhaphy were analyzed. RESULTS: 104 cases among the 145 indirect inguinal hernia (71.7%) were operated with only deep inguinal ring (DIR) reconstruction as author modified. In 41 cases (28.3%), posterior wall reconstruction was done simultaneously. There was no recurrence or reoperation case during the follow-up period. The incidence of postoperative chronic pain at postoperative 3 months of VAS greater than 3.0 was 2.2% (3 cases). CONCLUSIONS: Author's modification of Marcy operation was feasible anatomically in all indirect inguinal hernia repair, which is theoretically superior to classic Marcy operation in that repositioning the DIR more laterally and securing the obliquity and shutter action of the DIR. Result is at least not inferior in the aspect of short-term recurrence and chronic post-herniorrhaphy pain.

Augmented decision-making for acral lentiginous melanoma detection using deep convolutional neural networks.

BACKGROUND: Several studies have achieved high-level performance of melanoma detection using convolutional neural networks (CNNs). However, few have described the extent to which the implementation of CNNs improves the diagnostic performance of the physicians. OBJECTIVE: This study is aimed at developing a CNN for detecting acral lentiginous melanoma (ALM) and investigating whether its implementation can improve the initial decision for ALM detection made by the physicians. METHODS: A CNN was trained using 1072 dermoscopic images of acral benign nevi, ALM and intermediate tumours. To investigate whether the implementation of CNN can improve the initial decision for ALM detection, 60 physicians completed a three-stage survey. In Stage I, they were asked for their decisions solely on the basis of dermoscopic images provided to them. In Stage II, they were also provided with clinical information. In Stage III, they were provided with the additional diagnosis and probability predicted by the CNN. RESULTS: The accuracy of ALM detection in the participants was 74.7% (95% confidence interval [CI], 72.6-76.8%) in Stage I and 79.0% (95% CI, 76.7-81.2%) in Stage II. In Stage III, it was 86.9% (95% CI, 85.3-88.4%), which exceeds the accuracy delivered in Stage I by 12.2%p (95% CI, 10.1-14.3%p) and Stage II by 7.9%p (95% CI, 6.0-9.9%p). Moreover, the concordance between the participants considerably increased (Fleiss-κ of 0.436 [95% CI, 0.437-0.573] in Stage I, 0.506 [95% CI, 0.621-0.749] in Stage II and 0.684 [95% CI, 0.621-0.749] in Stage III). CONCLUSIONS: Augmented decision-making improved the performance of and concordance between the clinical decisions of a diverse group of experts. This study demonstrates the potential use of CNNs as an adjoining, decision-supporting system for physicians' decisions.

Non-melanoma skin cancer as a clinical marker for internal malignancies: a nationwide population-based cohort study.

INTRODUCTION: Non-melanoma skin cancers (NMSCs) are the most common cancers in the world, but the risk of internal malignancy in patients with NMSC has not been well investigated. OBJECTIVES: We aimed to assess the risk of internal malignancy in patients with NMSC compared with controls without NMSC in Korean population. METHODS: This nationwide cohort study, compared 27 259 NMSC patients with 54 518 matched controls without NMSC, 40 years or older using the data from Korea Health Insurance Review and Assessment Service from 2007 to 2016. The first 2 years were washout period, and we followed the patients for 8 years to observe the development of any internal malignancies after a diagnosis of NMSC. The Cox proportional hazard model was used to determine the hazard ratios (HRs) for developing internal malignancies. RESULTS: The overall risk of internal malignancies at all sites was 2727.7 and 1392.4 per 100 000 person-years for the patients with NMSC and controls, respectively. The risk was significantly higher in the patients with NMSC (HR 1.866, 95% confidence interval [CI] 1.768-1.970). Bone cancer showed the highest risk (HR 12.745, 95% CI 6.288-25.834), followed by nasal cavity and larynx (HR 10.279, 95% CI 6.178-7.103), oral cavity and pharynx (HR 10.211, 95% CI 7.375-14.137), anus and anal canal (HR 8.147, 95% CI 3.893-17.051) and cervical (HR 5.900, 95% CI 3.694-9.423) cancers with risks greater than fivefold higher in NMSC patients compared with the controls. The risks of cancers of the thorax, oesophagus, breast, lung, stomach, thyroid gland and non-Hodgkin's lymphoma were also statistically higher in the patients with NMSC. In contrast, the risks of cancers of the colon and rectum were found to be significantly decreased in the patients with NMSC (HR 0.765, 95% CI 0.657-0.890). CONCLUSION: Patients with NMSC require careful screening and follow-up for internal malignancy.

Mohs micrographic surgery for dermatofibrosarcoma protuberans: comparison of frozen and paraffin techniques.

BACKGROUND: Due to the propensity for local recurrence, Mohs micrographic surgery (MMS) has been suggested for the treatment of dermatofibrosarcoma protuberans (DFSP) and it has shown improved clinical outcomes. Recently, some authors suggested that MMS using paraffin-embedded sections (paraffin MMS) is superior in DFSP treatment compared with the conventional frozen MMS method. However, there have been no studies comparing frozen and paraffin MMS for the treatment of DFSP. OBJECTIVES: To compare the outcomes between DFSP patients who underwent frozen MMS and paraffin MMS. METHODS: Seventy-one DFSP patients treated with frozen MMS (n = 30) or paraffin MMS (n = 41) from 2003 to 2017 at a single institution were retrospectively reviewed. Recurrence rate and recurrence-free survival between frozen and paraffin MMS were assessed. RESULTS: During the mean follow-up duration of 25.4 months, four patients (frozen MMS, n = 1; and paraffin MMS, n = 3) showed recurrence after MMS. Although the local recurrence rate of the frozen MMS group (3.3%) was lower than that of the paraffin MMS group (7.3%), the difference was not statistically significant. In addition, recurrence-free survival was not significantly different between the two groups (P = 0.168). CONCLUSIONS: Frozen MMS, which has the advantages of shorter surgery time and immediate closure, is as effective as paraffin MMS in the treatment of DFSP.

A multicentre, open, investigator-initiated phase IV clinical trial to evaluate the efficacy and safety of ingenol mebutate gel, 0·015% on the face and scalp, and 0·05% on the trunk and extremities, in Korean patients with actinic keratosis (PERFECT).

BACKGROUND: Ingenol mebutate gel is a novel, field-directed topical treatment for actinic keratosis (AK). Most pivotal studies have targeted Western populations. No clinical study has been conducted to investigate its efficacy and safety in Asian populations. OBJECTIVES: To evaluate the efficacy and safety of ingenol mebutate gel for treating AK of face/scalp and trunk/extremities in a large Asian (Korean) population. PATIENTS AND METHODS: In this multicentre, open-label, interventional, parallel-group, prospective phase IV study (PERFECT, trial registration no.: NCT02716714), the eligible patients were allocated into either the face/scalp or the trunk/extremities group, according to their selected treatment area location. After application of ingenol mebutate gel, the participants were followed up for 6 months. The primary efficacy endpoint was complete clearance (CC) of AK lesions in the selected treatment area at day 57. Quality of life was evaluated using Skindex-29. Safety endpoints included local skin responses, scar, pigmentation, pain and adverse events. RESULTS: In total, 78·1% [95% confidence interval (CI) 66·86-86·92%] of subjects had CC at day 57, with 76·6% (95% CI 64·31-86·25%) in the face/scalp group and 88·9% (95% CI 51·75-99·72%) in the trunk/extremities group. Among them, CC was sustained in 88·9% (48 of 54, 95% CI 77·37-95·81%) at month 6. The local skin responses significantly increased 1 day after the treatment compared with baseline, and decreased afterwards. Among the total subjects, 7·8% (6 of 77) had hyperpigmentation on the application area. Scars were not reported. CONCLUSIONS: Ingenol mebutate is effective for the treatment of AK in Asians, with tolerable safety profiles.

Anabolic payout of terminal implant alters adipogenic gene expression of the longissimus muscle in beef steers.

This experiment evaluated the dose and payout pattern of trenbolone acetate (TBA) and estradiol-17ß (E) on LM mRNA expression of adenosine monophosphate-activated protein kinase-ɑ (-ɑ), ß, G protein-coupled receptor 41(), G protein-coupled receptor 43 (), γ, and stearoyl CoA desaturase () in finishing feedlot steers as indicators of adipogenesis and marbling development. British × Continental steers (n = 168; 14 pens/treatment; initial BW = 362 kg) were used in a randomized complete block design. Treatments included: no implant (NI), Revalor-S (REV-S; 120 mg TBA + 24 mg E), or Revalor-XS (REV-X; delayed release implant: 80 mg TBA + 16 mg E [uncoated], 120 mg TBA + 24 mg E [coated], 200 mg TBA + 40 mg E [total]). Steers were fed 1 time daily for an average of 164 d. The LM biopsies were collected (1 steer/pen) on d -1, 27, 55, and 111 relative to timing of implant. Total RNA was isolated from each sample and real-time quantitative PCR was used to measure quantity of -ɑ, ß, , ,it, γ, and mRNA. No implant × day interactions were detected ( ≥ 0.19) in this experiment. Day impacted the mRNA expression of all adipogenic genes ( ≤ 0.02). The main effect of implant tended ( = 0.09) to influence expression of -ɑ, REV-X had an 8.8% increase over NI and an 18.7% increase over REV-S. Implant influenced ( = 0.03) mRNA expression of , expression of for the REV-X treatment was not different ( > 0.10) from NI, and both were greater ( ≤ 0.05) than REV-S (1.13, 1.00, and 0.67 ± 0.224 arbitrary units) for REV-X, NI, and REV-S, respectively. Implant also influenced ( = 0.02) expression of , expression of for REV-X was not different ( > 0.10) from NI, and both were greater ( ≤ 0.05) than REV-S (1.27, 1.07, and 0.72 ± 0.234 arbitrary units) for REV-X, NI, and REV-S, respectively. Implant influenced ( = 0.02) mRNA expression of γ in LM tissue, expression of γ for REV-X was not different ( > 0.10) from NI, and both were greater ( ≤ 0.05) than REV-S (1.09, 1.02, and 0.69 ± 0.195 arbitrary units) for REV-X, NI, and REV-S, respectively. The REV-X steers received the greatest anabolic dose of TBA + E without detriment to marbling scores. The increased mRNA expression of adipogenic genes for REV-X steers suggest that the delayed and gradual release of anabolic stimulants associated with REV-X might have mitigated decreases in marbling generally attributed to multiple combined TBA + E implants.

Oncogenic BRAF fusions in mucosal melanomas activate the MAPK pathway and are sensitive to MEK/PI3K inhibition or MEK/CDK4/6 inhibition.

Despite remarkable progress in cutaneous melanoma genomic profiling, the mutational landscape of primary mucosal melanomas (PMM) remains unclear. Forty-six PMMs underwent targeted exome sequencing of 111 cancer-associated genes. Seventy-six somatic nonsynonymous mutations in 42 genes were observed, and recurrent mutations were noted on eight genes, including TP53 (13%), NRAS (13%), SNX31 (9%), NF1 (9%), KIT (7%) and APC (7%). Mitogen-activated protein kinase (MAPK; 37%), cell cycle (20%) and phosphatidylinositol 3-kinase (PI3K)-mTOR (15%) pathways were frequently mutated. We biologically characterized a novel ZNF767-BRAF fusion found in a vemurafenib-refractory respiratory tract PMM, from which cell line harboring ZNF767-BRAF fusion were established for further molecular analyses. In an independent data set, NFIC-BRAF fusion was identified in an oral PMM case and TMEM178B-BRAF fusion and DGKI-BRAF fusion were identified in two malignant melanomas with a low mutational burden (number of mutation per megabase, 0.8 and 4, respectively). Subsequent analyses revealed that the ZNF767-BRAF fusion protein promotes RAF dimerization and activation of the MAPK pathway. We next tested the in vitro and in vivo efficacy of vemurafenib, trametinib, BKM120 or LEE011 alone and in combination. Trametinib effectively inhibited tumor cell growth in vitro, but the combination of trametinib and BKM120 or LEE011 yielded more than additive anti-tumor effects both in vitro and in vivo in a melanoma cells harboring the BRAF fusion. In conclusion, BRAF fusions define a new molecular subset of PMM that can be targeted therapeutically by the combination of a MEK inhibitor with PI3K or cyclin-dependent kinase 4/6 inhibitors.

Biological responses of beef steers to steroidal implants and zilpaterol hydrochloride.

British × Continental steers (n = 168; 7 pens/treatment; initial BW = 362 kg) were used to evaluate the effect of dose/payout pattern of trenbolone acetate (TBA) and estradiol-17ß (E2) and feeding of zilpaterol hydrochloride (ZH) on serum urea-N (SUN), NEFA, IGF-I, and E2 concentrations and LM mRNA expression of the estrogen (ER), androgen (ANR), IGF-I (IGF-IR), ß1-adrenergic (ß1-AR), and ß2-adrenergic (ß2-AR) receptors and IGF-I. A randomized complete block design was used with a 3 × 2 factorial arrangement of treatments. Main effects were implant (no implant [NI], Revalor-S [REV-S; 120 mg TBA + 24 mg E2], and Revalor-XS [REV-X; 200 mg TBA + 40 mg E2]) and ZH (0 or 8.3 mg/kg of DM for 20 d with a 3-d withdrawal). Steers were fed for 153 or 174 d. Blood was collected (2 steers/pen) at d -1, 2, 6, 13, 27, 55, 83, 111, and 131 relative to implanting; LM biopsies (1 steer/pen) were collected at d -1, 27, 55, and 111. Blood and LM samples were collected at d -1, 11, and 19 relative to ZH feeding. A greater dose of TBA + E2 in combination with ZH increased ADG and HCW in an additive manner, suggesting a different mechanism of action for ZH and steroidal implants. Implanting decreased (P < 0.05) SUN from d 2 through 131. Feeding ZH decreased (P < 0.05) SUN. Serum NEFA concentrations were not affected by implants (P = 0.44). There was a day × ZH interaction (P = 0.06) for NEFA; ZH steers had increased (P < 0.01) NEFA concentrations at d 11 of ZH feeding. Serum E2 was greater (P < 0.05) for implanted steers by d 27. Serum trenbolone-17ß was greater (P < 0.05) for implanted steers by d 2 followed by a typical biphasic release rate, with a secondary peak at d 111 for REV-X (P < 0.05) implanted steers. Implanting did not affect mRNA expression of the ANR or ER, but the IGF-IR and the ß1-AR and ß2-AR were less (P < 0.05) for REV-S than NI at d 55 and ß2-AR mRNA was less (P < 0.05) for REV-S than for REV-X. Expression of the IGF-IR and the ß1-AR at d 111 was greater (P< 0.05) for REV-X than for REV-S and NI at d 111, and the ß2-AR was less (P< 0.05) for REV-S than for REV-X. Feeding ZH did not affect mRNA expression of the ß1-AR and ß2-AR. Both implanting and feeding ZH decreased SUN, but a greater dose of TBA + E2 did not result in further decreases. In addition, feeding ZH increased serum NEFA concentrations. Metabolic changes resulting from implanting and feeding ZH may aid in explaining steer performance and carcass responses to these growth promotants.

A phase II study of gemcitabine and cisplatin plus sorafenib in patients with advanced biliary adenocarcinomas.

BACKGROUND: This study evaluated the addition of sorafenib to gemcitabine and cisplatin in biliary adenocarcinoma first-line therapy. METHODS: Patients with advanced biliary adenocarcinomas received gemcitabine 1000 mg m(-2) and cisplatin 25 mg m(-2) on a 2 weeks on/1 week off cycle and sorafenib 400 mg twice daily. After the initial 16 patients were enrolled, the chemotherapy doses were amended in view of grade 3 and 4 hand-foot skin reaction and haematologic toxicity. Subsequently, 21 patients received gemcitabine 800 mg m(-2), cisplatin 20 mg m(-2) and sorafenib 400 mg. The primary end point was an improvement in 6-month progression-free survival (PFS6) from historical 57-77% (90% power, type I error of 10%). Pretreatment pERK, evaluated by immunostaining, was correlated with clinical outcome. RESULTS: A total of 39 patients were accrued. The most common grade 3-4 toxicities noted in >10% of patients were fatigue, elevated liver function tests and haematologic toxicities including thromboemboli, hyponatraemia and hypophosphataemia. Six-month progression-free survival was 51% (95% confidence interval (CI) 34-66%). Median PFS and overall survival were 6.5 (95% CI: 3.5-8.3) and 14.4 months (95% CI: 11.6-19.2 months), respectively. No correlation was observed between pERK and outcomes. CONCLUSION: The addition of sorafenib to gemcitabine and cisplatin in biliary adenocarcinomas did not improve efficacy over historical data, and toxicity was increased.

Patient perception and knowledge on total joint replacement surgery.

OBJECTIVES: To study patients' perceptions and knowledge about total joint replacement surgery. DESIGN; Cross-sectional survey. SETTING; University teaching hospital, Hong Kong. PATIENTS: Three hundred consecutive patients with the diagnosis of osteoarthritis or inflammatory arthritis attending the out-patient clinic from June 2010 to May 2011. MAIN OUTCOME MEASURES: Patients' knowledge and how they got the knowledge about total joint replacement surgery, and concerns about the outcome of such operations. RESULTS: Whilst 94% of the patients knew about total joint replacement surgery, 77% obtained such knowledge from their friends and relatives. The three most common concerns related to this type of operation were whether they might: be wheelchair bound after surgery (64%), need to be taken care of by others for more than 3 months (61%), and have post-surgery complications (54%). Most of them recognised the advantages of the surgery, 82% knew about good pain relief after surgery, and 87% realised that total joint replacement surgery could improve their mobility. Patients did not have a realistic idea regarding the survival of the prosthesis; 41% thought the prosthesis might last for less than 10 years and 34% had no idea about its longevity. CONCLUSION; Patients did recognise the advantages of total joint replacement surgery in treating arthritis. However, they had many concerns about its outcome that warrant clarification. Public education on these aspects is necessary to address concerns, and may be achieved in cooperation with the media.

Comparison of negative pressure wound therapy and secondary intention healing after excision of acral lentiginous melanoma on the foot.

BACKGROUND: Melanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot and wide excision usually results in a substantial defect. Various repair methods, including free flap, full-thickness skin graft and secondary intention healing (SIH), are used to repair these defects. Recently, use of negative pressure wound treatment (NPWT) has been shown to accelerate wound healing in different types of wound. OBJECTIVES: To compare the functional and cosmetic results of NPWT and SIH in patients who underwent wide excision of melanomas on the foot. METHODS: The wound defects of 22 patients after wide excision of melanoma on the foot were treated using SIH (n = 13) or NPWT (n = 9). RESULTS: There was no significant difference in time to complete wound healing between the two groups. However, evaluation using the Vancouver Burn Scar Assessment Scale at the time of complete healing showed that the mean score of the NPWT group was significantly lower than that of the SIH group. The NPWT group also had significantly better results than the SIH group in terms of total score, vascularity and height of the scars. As for complications, no wound infection was encountered in the NPWT group, whereas eight of the 13 patients in SIH group had wound infections during the course of treatment despite frequent and meticulous aseptic dressing changes. CONCLUSIONS: These results show that, despite the drawback of rather prolonged healing time, NPWT is an excellent therapeutic option for wounds after wide excision of melanoma on the foot, with acceptable functional and cosmetic outcomes.

Administration of estradiol, trenbolone acetate, and trenbolone acetate/estradiol implants alters adipogenic and myogenic gene expression in bovine skeletal muscle.

Twenty crossbred yearling steers (421 kg) were used to evaluate the effects of implanting with trenbolone acetate (TBA; 120 mg), estradiol-17ß (E(2); 25.7 mg), and a combination (120 mg of TBA and 24 mg of E(2)) on adipogenic and myogenic mRNA concentrations. Animals were blocked by BW and within each block were assigned to 1 of 4 treatments. Animals were housed and fed in individual pens with 5 animals per treatment. All animals were weighed weekly, and muscle biopsy samples were taken from the LM of each steer on d 0 (before implantation), 7, 14, and 28. Total RNA was isolated from each sample and real-time quantitative PCR was used to measure the quantity of C/EBPß, PPARγ, stearoyl CoA desaturase (SCD), myogenin, and 3 isoforms of bovine myosin heavy chain (MHC) mRNA. Total BW gain from the 28-d period was adjusted to d 0 by use of covariant analysis, and steers in the implant groups tended (P = 0.09) to have increased BW gain compared with nonimplanted control steers. Analysis of the gene expression of MHC showed that neither implant nor day (P > 0.20) had a significant effect on the expression of type I or IIX MHC mRNA There was also no treatment effect (P > 0.20) on MHC-IIA and myogenin, but increasing days on feed increased (P = 0.05) the expression of MHC-IIA mRNA. Relative mRNA abundance of C/EBPß, PPARγ, and SCD increased (P < 0.05) during days of feed but PPARγ decreased (P < 0.05) with the treatment of combined TBA/E(2) implant. Results of this study indicate that implanting with TBA, E(2), or both increased BW gain and decreased adipogenic gene expression of finishing steers without significantly affecting the concentration of type I, IIA, or IIX MHC mRNA. Increasing days on feed increased both MHC-IIA and adipogenic gene expression in bovine skeletal muscle biopsy samples. We conclude that administration of steroidal implants had no effect on the proportion of the 3 MHC mRNA isoforms but decreased C/EBPß, PPARγ, and SCD mRNA in bovine skeletal muscle.

Mucosal protective effect of PGI2 on canine small bowel auto-transplantation.

PURPOSE: We designed this experimental study to assess the mucosal protective effects of continuous prostaglandin I2 (PGI2) infusion after canine small bowel autotransplantation. MATERIALS AND METHODS: Six Mongrel dogs were randomly divided two groups: PGI2 (n = 3) and control (n = 3). The small bowel from jejunum to ileum was obtained, including the mesenteric vascular pedicle. After cold flushing ex vivo, the harvested segment was preserved in an icebox for 3 hours. Thereafter we reimplanted the harvested intestinal segment. While completing the anastomosis, PGI2 (50 µg) was slowly infused through the mesenteric artery in the PGI2 group versus the same volume of saline in the control group. At 1, 3 and 6 days after autotransplantation, we obtained blood samples, and at 6 days, small bowel segments. Endotoxin and interleukin 6 (IL-6) levels were measured and all histologic specimens stained with hematoxylin-eosin H-E were reviewed by a pathologist to grade mucosal damage as: mild (1 point), moderate (2 points), or severe (3 points) change. RESULTS: Mean basal serum endotoxin levels were similar in both groups the PGI2 groups versus control group were 0.216 ± 0.018 versus 0.223 ± 0.040 EU/mL, respectively. However, on day 3 after the operation, the PGI2 group showed much decreased levels of serum endotoxin compared to control levels: 0.349 ± 0.196 versus 0.842 ± 0.446 EU/mL. The mean concentration of serum IL-6 on day 1 after operation among the PGI2 versus control group were 32.13 ± 7.13 pg/mL versus 36.96 ± 3.65 pg/mL. The histologic scores at 6 days after the operation were PGI2 group versus control group: 1.33 versus 1.66 (P = NS). CONCLUSION: Continuous infusions of PGI2 through the mesenteric artery after the canine small bowel autotransplantation may protect the small bowel mucosal barrier.

Clinical characteristics and risk of melanoma development from giant congenital melanocytic naevi in Korea: a nationwide retrospective study.

BACKGROUND: Giant congenital melanocytic naevi (GCMN) are known risk factors for the development of melanoma. However, melanoma risk among Asians is rarely evaluated. OBJECTIVES: To evaluate the clinical characteristics and risk of melanoma development from GCMN in Koreans, we performed a nationwide retrospective cohort study in Korea. GCMN were defined as those comprising ≥5% body surface area in children or measuring ≥20cm in adults. METHODS: In total, 131 patients with GCMN were enrolled, with a mean age of 10·3years (range: birth-70years). RESULTS: The posterior trunk was the most common site (67, 51·1%), followed by lateral trunk, anterior trunk, legs, both anterior and posterior trunk, buttocks, and arms. Satellite naevi were present in 69 cases (52·7%), and axial areas were more commonly involved in patients with satellite naevi than in those without satellite lesions. Atypical features such as rete ridge elongation and bridges were seen, and, among these, pagetoid spread and ballooning cell changes were more common in patients <4years old. Proliferative nodules were found in three cases. Melanomas had developed in three of 131 patients (2·3%; a 6-year-old girl, a 14-year-old girl and a 70-year-old man), and the incidence rate was 990 per 100000 person-years. Melanomas in these three patients consisted of two cutaneous melanomas and one extracutaneous meningeal melanoma. CONCLUSIONS: We should be aware of melanoma development from GCMN, and lifelong follow-up is required due to the risk of melanoma arising in GCMN.

Performance of finishing beef steers in response to anabolic implant and zilpaterol hydrochloride supplementation.

Our objectives were to evaluate the dose/payout pattern of trenbolone acetate (TBA) and estradiol-17ß (E(2)) implants and feeding of zilpaterol hydrochloride (ZH) on performance and carcass characteristics of finishing beef steers. A randomized complete block design was used with a 3 × 2 factorial arrangement of treatments. British × Continental steers (n = 168; initial BW = 362 kg) were blocked by BW and allotted randomly to 42 pens (7 pens/treatment; 6 pens/block; 4 steers/pen). The main effects of treatment were implant [no implant (NI); Revalor-S (REV-S; 120 mg of TBA + 24 mg of E(2)); and Revalor-XS (REV-X; 200 mg of TBA + 40 mg of E(2))] and ZH (0 or 8.3 mg/kg of DM for 20 d with a 3-d withdrawal before slaughter). Blocks were split into 2 groups, and block groups were fed for either 153 or 174 d. No implant × ZH interactions were noted for cumulative performance data. Overall, shrunk final BW (567, 606, and 624 kg for NI, REV-S, and REV-X, respectively), ADG (1.25, 1.51, and 1.60 kg), and G:F (0.14, 0.16, and 0.17) increased (P < 0.05) as TBA and E(2) dose increased. Implanting increased (P < 0.05) DMI, but DMI did not differ (P > 0.10) between REV-S and REV-X (8.8 for NI vs. 9.4 kg/d for the 2 implants). From d 1 to 112 of the feeding period, implanting increased (P < 0.05) ADG and G:F, but REV-S and REV-X did not differ (P > 0.10). From d 112 to end, ADG increased by 19% (P < 0.05) and G:F was 18% greater (P < 0.05) for REV-X vs. REV-S. Carcass-adjusted final BW (29-kg difference), ADG (0.2-kg/d difference), and G:F (0.02 difference) were increased (P < 0.05) by ZH, but daily DMI was not affected by feeding ZH. Hot carcass weight was increased (P < 0.05) by ZH (19-kg difference) and implant, with REV-X resulting in the greatest response (HCW of 376 for NI vs. 404 and 419 kg for REV-S and REV-X, respectively; P < 0.05). An implant × ZH interaction (P = 0.05) occurred for dressing percent (DP). Without ZH, implanting increased DP, but DP did not differ (P > 0.10) between REV-X and REV-S. With ZH, REV-X increased (1.7%; P < 0.05) DP vs. NI and REV-S. Marbling score, 12th-rib fat, and KPH were not affected (P > 0.10) by implant or ZH. Overall, treatment increased steer performance and HCW in an additive fashion, suggesting different mechanisms of action for ZH and steroidal implants. In addition, a greater dose of TBA + E(2) and extended payout improved steer performance and HCW.

Dose and release pattern of anabolic implants affects growth of finishing beef steers across days on feed.

Four experiments evaluated the effect of implant dose and release pattern on performance and carcass traits of crossbred beef steers. In Exp. 1, steers (4 to 7 pens/treatment; initial BW = 315 kg) were fed an average of 174 d. Treatments were 1) no implant (NI); 2) Revalor-S [120 mg of trenbolone acetate (TBA) and 24 mg of estradiol 17ß (E(2)); REV-S]; 3) Revalor-IS followed by REV-S (cumulatively 200 mg of TBA and 40 mg of E(2); reimplanted at 68 to 74 d; REV-IS/S); and 4) Revalor-XS (200 mg of TBA and 40 mg of E(2); REV-X). Carcass-adjusted final BW was greater (P < 0.05) for REV-X and REV-IS/S than for REV-S (610, 609, and 598 kg, respectively). Daily DMI did not differ (P > 0.10) among the 3 implants, but carcass-adjusted G:F was greater (P < 0.05) for REV-X and REV-IS/S than for REV-S (0.197 and 0.195 vs. 0.188). Both HCW and LM area were greater (P < 0.05) for REV-X and REV-IS/S than for REV-S. Marbling scores were greatest (P < 0.05) for REV-S and least (P < 0.05) for REV-IS/S; REV-X was intermediate to NI and REV-IS/S. In Exp. 2, steers (10 pens/treatment; initial BW = 391 kg) were fed 131 d, with treatments of REV-S, REV-IS/S (reimplanted at 44 to 47 d), and REV-X. Carcass-adjusted final BW (598 kg), ADG (1.6 kg), DMI (9.4 kg), G:F (0.17), and HCW did not differ (P > 0.10) among treatments. The percentage of Choice was less (P < 0.05) and percentage of Select greater (P < 0.05) for REV-IS/S than for REV-S and REV-X. In Exp. 3, steers (10 pens/treatment; initial BW = 277 kg) were fed 197 d and received either REV-IS/S (reimplanted at 90 to 103 d) or REV-X. Carcass-adjusted final BW (625 vs. 633 kg) and ADG (1.81 vs. 1.76 kg) were greater (P < 0.05) for REV-X-implanted steers. Daily DMI did not differ, but G:F tended (P < 0.10) to be increased and HCW was greater (P < 0.05) for REV-X than for REV-IS/S. In Exp. 4, steers (8 pens/treatment; initial BW = 238 kg) were fed 243 d and received either REV-IS/S (reimplanted at 68 to 71 d) or REV-X. Carcass-adjusted final BW (612 kg), ADG (1.54 kg), DMI (7.55), and G:F (0.21) did not differ (P > 0.10) for REV-IS/S and REV-X-implanted steers. Carcass traits did not differ among implants, but the percentage of Choice carcasses was greater (P < 0.05) and percentage of Select was less (P < 0.05) for REV-X than for REV-IS/S. These data indicate that when TBA/E(2) dose is equal, the altered release rate of REV-X can improve performance and quality grade, but these effects depend on duration of the feeding period and timing of initial and terminal implants.