Co-existence of atypical tuberculid with lupus vulgaris.

Cutaneous tuberculosis (CTB) is an uncommon form of extra-pulmonary tuberculosis accounting for ≤2% of mycobacterium tuberculosis cases and is more often reported from developing countries. Tuberculid, a cutaneous hypersensitivity reaction to mycobacteria or its fragments, is a another rare cutaneous manifestation seen in association with tuberculosis of other organ systems including tuberculous lymphadenitis, pulmonary tuberculosis, etc. Co-occurrence of a tuberculid with CTB is extremely rare. Herein we report a childhood case of lupus vulgaris, a type of CTB, associated with an atypical presentation of tuberculid.

Splenic Rupture Secondary to Metastatic Undifferentiated Pleomorphic Sarcoma of the Spleen: A Rare Presentation of an Exceptionally Rare Entity.

Splenic malignancies are uncommonly encountered in routine practice, and they are often only detected incidentally, posing a clinical challenge. Primary malignant neoplasms of the spleen are rare, and sarcomas are by far the rarest. The undifferentiated pleomorphic sarcoma type is an exceptionally rare and aggressive type with only a handful of cases reported in literature thus far. Herein, we present the case of a 49-year-old, with a previous finding of a heterogeneous splenomegaly on imaging for an unrelated medical complaint, presenting with an acute abdomen secondary to a ruptured spleen. The diagnosis of high-grade primary undifferentiated pleomorphic sarcoma of the spleen was made, and with further investigations, suspicious hepatic lesions were identified and later confirmed to be metastases.

H syndrome: A review of treatment options and a hypothesis of phenotypic variability.

H syndrome is a rare autosomal recessive disorder with clinical features comprising: hyperpigmentation, hypertrichosis, hearing loss, heart anomalies, low height, hypogonadism and hepatosplenomegaly. H syndrome results from loss-of-function mutations in SLC29A3 which leads to abnormal proliferation and function of histiocytes. Herein, we discuss the considerable phenotypic heterogeneity detected in a consanguineous Egyptian family comprising of four affected siblings, two of which are monozygotic twin and the possible therapeutics. The phenotypic variability may be attributed to the role of histiocytes in the tissue response to injury. Such variable expressivity of H syndrome renders the diagnosis challenging and delays the management. The different treatment approaches used for this rare entity are reviewed.

Housing Prices and the Skills Composition of Neighborhoods.

In the United States (US), low-income workers are being pushed away from city centers where the cost of living is high. The effects of such changes on labor mobility and housing price have been explored in the literature. However, few studies have focused on the occupations and specific skills that identify the most susceptible workers. For example, it has become increasingly challenging to fill the service sector jobs in the San Francisco (SF) Bay Area because appropriately skilled workers cannot afford the growing cost of living within commuting distance. With this example in mind, how does a neighborhood's skill composition change as a result of higher housing prices? Are there certain skill sets that are being pushed to the geographical periphery of a city despite their essentialness to the city's economy? Our study focuses on the impact of housing prices with a granular view of skills compositions to answer the following question: Has the density of cognitive skill workers been increasing in a gentrified area? We hypothesize that, over time, low-skilled workers are pushed away from downtown or areas where high-skill establishments thrive. Our preliminary results show that high-level cognitive skills are getting closer to the city center indicating adaptation to the increase of median housing prices as opposed to low-level physical skills that got further away. We examined tracts that the literature indicates as gentrified areas and found a pattern in which there is a temporal increase in median housing prices and the number of business establishments coupled with an increase in the percentage of skilled cognitive workers.

CD8+CD103+ tissue-resident memory T cells convey reduced protective immunity in cutaneous squamous cell carcinoma.

BACKGROUND: Tumor infiltrating lymphocytes play a key role in antitumor responses; however, while several memory T-cell subtypes have been reported in inflammatory and neoplastic conditions, the proportional representation of the different subsets of memory T cells and their functional significance in cancer is unclear. Keratinocyte skin cancer is one of the most common cancers globally, with cutaneous squamous cell cancer (cSCC) among the most frequent malignancies capable of metastasis. METHODS: Memory T-cell subsets were delineated in human cSCCs and, for comparison, in non-lesional skin and blood using flow cytometry. Immunohistochemistry was conducted to quantify CD103+ cells in primary human cSCCs which had metastasized (P-M) and primary cSCCs which had not metastasized (P-NM). TIMER2.0 (timer.cistrome.org) was used to analyze TCGA cancer survival data based on ITGAE expression. Immunofluorescence microscopy was performed to determine frequencies of CD8+CD103+ cells in P-M and P-NM cSCCs. RESULTS: Despite intertumoral heterogeneity, most cSCC T cells were CCR7-/CD45RA- effector/resident memory (TRM) lymphocytes, with naive, CD45RA+/CCR7- effector memory re-expressing CD45RA, CCR7+/L-selectin+ central memory and CCR7+/L-selectin- migratory memory lymphocytes accounting for smaller T-cell subsets. The cSCC CD8+ T-cell population contained a higher proportion of CD69+/CD103+ TRMs than that in non-lesional skin and blood. These cSCC CD69+/CD103+ TRMs exhibited increased IL-10 production, and higher CD39, CTLA-4 and PD-1 expression compared with CD103- TRMs in the tumor. CD103+ cells were more frequent in P-M than P-NM cSCCs. Analysis of TCGA data demonstrated that high expression of ITGAE (encoding CD103) was associated with reduced survival in primary cutaneous melanoma, breast carcinoma, renal cell carcinoma, kidney chromophobe cancer, adrenocortical carcinoma and lower grade glioma. Immunofluorescence microscopy showed that the majority of CD103 was present on CD8+ T cells and that CD8+CD103+ cells were significantly more frequent in P-M than P-NM cSCCs. CONCLUSION: These results highlight CD8+CD103+ TRMs as an important functional T-cell subset associated with poorer clinical outcome in this cancer.

An interpretable approach for social network formation among heterogeneous agents.

Understanding the mechanisms of network formation is central in social network analysis. Network formation has been studied in many research fields with their different focuses; for example, network embedding algorithms in machine learning literature consider broad heterogeneity among agents while the social sciences emphasize the interpretability of link formation mechanisms. Here we propose a social network formation model that integrates methods in multiple disciplines and retain both heterogeneity and interpretability. We represent each agent by an "endowment vector" that encapsulates their features and use game-theoretical methods to model the utility of link formation. After applying machine learning methods, we further analyze our model by examining micro- and macro- level properties of social networks as most agent-based models do. Our work contributes to the literature on network formation by combining the methods in game theory, agent-based modeling, machine learning, and computational sociology.

Unpacking the polarization of workplace skills.

Economic inequality is one of the biggest challenges facing society today. Inequality has been recently exacerbated by growth in high- and low-wage occupations at the expense of middle-wage occupations, leading to a "hollowing" of the middle class. Yet, our understanding of how workplace skills drive this process is limited. Specifically, how do skill requirements distinguish high- and low-wage occupations, and does this distinction constrain the mobility of individuals and urban labor markets? Using unsupervised clustering techniques from network science, we show that skills exhibit a striking polarization into two clusters that highlight the specific social-cognitive skills and sensory-physical skills of high- and low-wage occupations, respectively. The connections between skills explain various dynamics: how workers transition between occupations, how cities acquire comparative advantage in new skills, and how individual occupations change their skill requirements. We also show that the polarized skill topology constrains the career mobility of individual workers, with low-skill workers "stuck" relying on the low-wage skill set. Together, these results provide a new explanation for the persistence of occupational polarization and inform strategies to mitigate the negative effects of automation and offshoring of employment. In addition to our analysis, we provide an online tool for the public and policy makers to explore the skill network: skillscape.mit.edu.