Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society.

BACKGROUND: Most studies on dermoscopy of acral lesions were conducted in Asian populations. In this study, we analyzed these features in a predominantly Caucasian population. OBJECTIVE: Estimate the prevalence of dermoscopic features in acral lesions, and assess their level of agreement between observers. METHODS: In this retrospective multicenter study, 167 acral lesions (66 melanomas) were evaluated for 13 dermoscopic patterns by 26 physicians, via a secured Internet platform. RESULTS: Parallel furrow pattern, bizarre pattern, and diffuse pigmentation with variable shades of brown had the highest prevalence. The agreement for lesion patterns between physicians was variable. Agreement was dependent on the level of diagnostic difficulty. CONCLUSION: Lesions with a diameter >1 cm were more likely to be melanoma. We found as well that a benign pattern can be seen in parts of melanomas. For this reason one should evaluate an acral lesion for the presence of malignant patterns first.

Dermoscopy of scalp tumours: a multi-centre study conducted by the international dermoscopy society.

BACKGROUND: Little is known about the dermoscopic features of scalp tumours. Objective To determine the dermoscopic features of scalp tumours. METHODS: Retrospective analysis of dermoscopic images of histopathologically diagnosed scalp tumours from International Dermoscopy Society members. RESULTS: A total of 323 tumours of the scalp from 315 patients (mean age: 52 years; range 3-88 years) were analysed. Scalp nevi were significantly associated with young age (<30 years) and exhibited a globular or network pattern with central or perifollicular hypopigmentation. Melanoma and non-melanoma skin cancer were associated with male gender, androgenetic alopecia, age >65 years and sun damage. Atypical network and regression were predictive for thin (≤1 mm) melanomas, whereas advanced melanomas (tumour thickness > 1 mm) revealed blue white veil, unspecific patterns and irregular black blotches or dots. CONCLUSIONS: The data collected provide a new knowledge regarding the clinical and dermoscopy features of pigmented scalp tumours.

An epidemiologic model for diabetes mellitus: incidence, prevalence, and mortality.

An epidemiologic model is developed to describe the incidence, prevalence, and mortality of diabetes. Available data are reviewed, analyzed, and applied to the model. The model provides a framework for understanding diabetes on a population basis, and is useful in identifying needs and facilitating health care planning.

Crosstalk between components of the blood brain barrier and cells of the CNS in microglial activation in AIDS.

During the progression of AIDS, a majority of patients develop cognitive disorders such as HIV encephalitis (HIVE) and AIDS dementia complex (ADC), which correlate closely with macrophage infiltration into the brain and microglial activation. Microglial activation occurs in response to infection, inflammation and neurological disorders including HIVE, Alzheimer's disease, Parkinson's disease and multiple sclerosis. Microglia can be activated by immunoreactive cells independent of, but enhanced by HIV infection, from at least two routes. Activation may occur from signals originating from activated monocytes and lymphocytes in the blood stream, which initiate a cascade of stimuli that ultimately reach microglia in the brain or from activated macrophages/microglia/astrocytes within the brain. Effects of microglial activation stemming from both systemic and CNS HIV infection act together to commence signaling feedback, leading to HIVE and increased neurodegeneration. Most recent data indicate that in AIDS patients, microglial activation in the brain with subsequent release of excitotoxins, cytokines and chemokines leads to neurodegeneration and cognitive impairment. Since the presence of HIV in the brain results from migration of infected monocytes and lymphocytes across the vascular boundary, the development of novel therapies aimed at protecting the integrity of the blood brain barrier (BBB) upon systemic HIV infection is critical for controlling CNS infection.

3-Alkyl-3-hydroxyglutaric acids: a new class of hypocholesterolemic HMG CoA reductase inhibitors. 1.

Derivatives of 3-hydroxy-3-methylglutaric acid (HMG), a portion of the substrate for HMG CoA reductase, were prepared and tested for their inhibitory action against rat liver HMG CoA reductase and for their hypocholesterolemic activity. Structure-dependent competitive inhibition was observed. Optimal structures had a free dicarboxylic acid with an alkyl group of 13-16 carbons at position 3. 3-n-Pentadecyl-3-hydroxyglutaric acid (3j) (IC50 = 50 microM) reduced serum cholesterol in the Triton-treated rat and HMG CoA reductase activity in the 20,25-diazacholesterol-treated rat.

Increasing the supply of cadaveric kidneys for transplantation.

The number of cadaveric kidneys currently available for transplantation is insufficient. Therefore, the Center for Disease Control (CDC) undertook a collaborative project with the two transplant programs in Georgia to increase te retrieval of cadaveric kidneys. We used retrospective analysis to select productive hospitals, hospital-specific surveillance systems to identify potential donors, and procurement and retrieval evaluation to identify preventable deficiencies. During 900 hospital months of prospective surveillance, we identified a total of 555 potential donors by death record review, giving a potential donor rate of 2.3 donors/100 deaths (110 kidneys/million population/year). We observed an increase in the number of referrals, consent obtained from next of kin, and kidneys retrieved. This period of intensive activity demonstrated that additional kidneys can be retrieved by using systematic methods.

Analysis of result variability from high-density oligonucleotide arrays comparing same-species and cross-species hybridizations.

There exists a significant limitation in the variety of organismsfor which microarrays have been developed because of a lack of genomic sequence data. A near-term solution to this limitation is to use microarrays designed for one species to analyze RNA samples from closely related species. The assumption is that conservation of gene sequences between species will be sufficient to generate a reasonable amount of good-quality data. While there have been relatively few published reports describing the use of microarrays for cross-species hybridizations, this technique is potentially a powerful tool for understanding genomics in model organisms such as nonhuman primates. Here we describe the analysis and comparison of hybridization characteristics and data variability from a set of cross-species (rhesus macaque) and same-species (human) hybridization experiments using human high-density Affymetrix oligonucleotide arrays. The data reveal that a large fraction of probe sets are effective at transcript detection in the cross-species hybridization, validating the application of cross-species hybridizations for nonhuman primate genomics research.

A valveless counterpulsation left ventricular assist pump in the descending aorta: hemodynamic benefit with a reduced risk of cerebral emboli.

Because of valve malfunction and cerebral embolism reported with use of the total artificial heart, the descending aorta was reexamined as a site for a valveless counterpulsation left ventricular assist pump. The pump was introduced into the thoracic aorta at the level of the eight thoracic vertebra in 11 canine right-heart bypass preparations. Heart rate (110 beats per minute), stroke volume (20 ml), and mean arterial pressure (80 or 100 mm Hg) were precisely controlled. The pump ejection volume was adjusted to equal 1 time or 2 times the stroke volume of the dog. A 20-ml ejection led to an 11% reduction in left atrial pressure, an 11% reduction in peak left ventricular pressure, and a 20% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). Systolic shortening (ultrasonic crystals) increased by 5% (p less than .05 at a mean arterial pressure of 80 mm Hg). A 40-ml pump ejection led to an 11% reduction in mean left atrial pressure, a 17% reduction in peak left ventricular pressure, and a 21% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). The systolic shortening increased by 15% (p less than .05). To assess the relative risk of cerebral embolism, albumin spheres (40 to 60 micrograms) labeled with technetium-99 were injected into the pump chamber in 5 dogs (40-ml ejection, 2.1 +/- 0.1 times the dog's stroke volume).(ABSTRACT TRUNCATED AT 250 WORDS)

Double-blind comparative trial of standard (commercial) and antibody-affinity-purified tetanus toxoid vaccines.

Tetanus toxoid purified by antibody-affinity chromatography, was compared with conventionally purified material in a double-blind trial in 205 healthy blood donors. There was neither any difference in immunogenicity as assessed by enzyme-linked immunoassay nor in side-reactions between the two vaccines. This study confirms that side-reactions to tetanus toxoid are not eliminated by purifying it.

The efficacy of a new formulation of trimethoprim and sulphadiazine in acute exacerbations of chronic bronchitis.

Thirty-four acute exacerbations of chronic bronchitis were treated using a new formulation of trimethoprim and sulphadiazine. Significant bacterial isolates were obtained in 18 exacerbations of which 12 comprised Haemophilus influenzae. Adverse effects of treatment, principally nausea, occurred in 5 patients. A satisfactory clinical response in association with the achievement of mucoid sputum was obtained in 94% and the mean time for sputum conversion of 3.8 days compares favourably with other antibiotics.

The effect of neonatal hyperbilirubinemia on the measurement of plasma creatinine.

Bilirubin interferes with the measurement of plasma creatinine by the kinetic colorimetric Jaffe reaction, the method currently used by many hospital laboratories. The purpose of the present study was to evaluate the influence of unconjugated bilirubin on the measurement of plasma creatinine by the AutoAnalyzer Jaffe end point method. This colorimetric method is slower but more precise and accurate in the range of 0.25 to 0.5 mg/dl. We found that bilirubin from jaundiced neonates and from stock solutions did not affect the determination of creatinine chromogen in plasma or in saline, even at concentrations as high as 25 mg/dl. We conclude that the use of the Jaffe end point AutoAnalyzer method with a blank run before each sample will provide an accurate measurement of creatinine in the plasma of the neonate with unconjugated hyperbilirubinemia.

Developing a safety protocol in qualitative research involving battered women.

Qualitative research involving battered women requires advanced planning to protect participants and the investigator from the risk of violence from an abusive partner. Domestic violence creates a potentially dangerous research environment that is seldom discussed in the literature. The use of a safety protocol has been advocated as a way to ensure that research is conducted with maximum safeguards for the participating women. In this article, the author presents a safety protocol developed for a study of battered women's perceptions of danger in their relationship. Issues that relate to safety contacting participants, conducting the interviews, and protecting data are discussed.

Telehealth's impact on nursing and the development of the interstate compact.

The information age has opened a new era for nursing practice. Advances in telecommunications technology now allow nurses to care for patients and their families in geographic locations throughout the country. This new practice environment challenges many of the assumptions that have created a state-based system of nurse practice acts and licensing. In response to this challenge, the creation of a new mechanism for licensure and practice, the interstate compact, is developing. In this article, the development and regulatory challenges created by telenursing and the interstate compact are discussed.

Using peer audit in health visiting.

South Tees Health Authority is one of 12 pilot sites for quality assurance. Most staff in the community and mental health unit are involved with the setting of professional standards. This article describes health visitors' experience of peer audit, carried out on one of the standards set within their quality assurance standard setting group. The nine health visitors attached to general practices serving Redcar and the surrounding district set professional standards based on Donabedian's structure, process and outcome model. Standards were set in areas such as communication, immunisation, health promotion, and child health clinics.

Cognitive deficits and degeneration of interneurons in HIV+ methamphetamine users.

The cellular basis for cognitive deficits in HIV+ patients with and without a history of methamphetamine (METH) use is unclear. We found that HIV+ METH users had more severe loss of interneurons that was associated with cognitive impairment. Compared with other markers, loss of calbindin and parvalbumin interneurons in the frontal cortex was the most significant correlate to memory deficits, suggesting a role in neurobehavioral alterations of HIV+ METH users.