Retrospective Analysis of a Modern Cohort of Dermatofibrosarcoma Protuberans From 2000 to 2018.

BACKGROUND: There is limited data on how demographics, tumor characteristics, and treatment methods affect overall survival in patients with dermatofibrosarcoma protuberans (DFSP). OBJECTIVE: To summarize characteristics of patients with DFSP, assess prognostic factors, and evaluate the impact of treatment modality on their overall survival. METHODS: We investigated DFSP using data for 4451 patients with histologically confirmed cases of DFSP diagnosed between 2000 and 2018 from the 18 US regional registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. RESULTS: Older age (P < .001) and large tumor size (P = .006) were significantly associated with worse overall survival in controlled analysis. Older age (P < .050), males (P < .001), non-white race (P < .001), and lower median household income (P < .010) were more likely to present with larger tumor size. Different treatments were associated with patient characteristics. Older age (P < .001), non-white race (P < .032), larger tumor size (P < .001), and head/neck location (P < .001) were associated with patients receiving surgery and radiation instead of surgery only. Additionally, men (P < .021), non-whites (P < .001), lower median household income (P < .001), and larger tumor size (P = .003) were less likely to have Mohs micrographic surgery performed over excision. CONCLUSIONS: Age at presentation and tumor size appeared to be notable prognostic factors. Although treatment modality did not significantly influence patient survival, certain patient characteristics are associated with different treatment modalities.

Energy Efficient Multicast Communication in Cognitive Radio Wireless Mesh Network.

Multicasting is a basic networking primitive used in a wide variety of applications that is also true for cognitive radio-based networks. Although cognitive radio technology is considered to be the most promising technology to deal with spectrum scarcity, it relates to completely different aspects of networking and presents new challenges. For cognitive radio-based multicast sessions, it is important to use the spectrum efficiently by reducing the number of channels used as well as engaging fewer nodes in data relaying. This will benefit the network in three ways. First, it will decrease the number of transmissions. Second, it will help to reduce energy usage. Third, it will spare more channels and relay nodes for simultaneous multicast sessions. To achieve these advantages, efficient channel selection and relay nodes are required based on hop-to-hop communication. In this paper an algorithm has been developed that attempts to minimize energy consumption by selecting the minimum possible number of relay nodes and channels for a multicast session, taking into account the sporadic availability of the spectrum. The proposed method performs effectively compared to the flooding method in terms of energy consumption for the provided examples in multicasting.

Plaque Rupture and Thrombosis: the Value of the Atherosclerotic Rabbit Model in Defining the Mechanism.

Persistent inflammation and mechanical injury associated with cholesterol crystal accretion within atherosclerotic plaques typically precedes plaque disruption (rupture and/or erosion) and thrombosis--often the terminal events of atherosclerotic cardiovascular disease. To elucidate the mechanisms of these events, the atherosclerotic rabbit model provides a unique and powerful tool that facilitates studies of atherogenesis starting with plaque buildup to eventual disruption. Examination of human coronary arteries obtained from patients who died with myocardial infarction demonstrates evidence of cholesterol crystals perforating the plaque cap and intimal surface of the arterial wall that can lead to rupture. These observations were made possible by omitting ethanol, an avid lipid solvent, from the tissue processing steps. Importantly, the atherosclerotic rabbit model exhibits a similar pathology of cholesterol crystals perforating the intimal surface as seen in ruptured human plaques. Local and systemic inflammatory responses in the model are also similar to those observed in humans. The strong parallel between the rabbit and human pathology validates the atherosclerotic rabbit model as a predictor of human pathophysiology of atherosclerosis. Thus, the atherosclerotic rabbit model can be used with confidence to evaluate diagnostic imaging and efficacy of novel anti-atherosclerotic therapy.

Impact of iodinated contrast shortage on contrast-associated acute kidney injury: a single center experience.

Background: In March 2022, a COVID-19 outbreak disrupted the global supply of iodine contrast media (ICM). Healthcare systems implemented contrast-saving strategies to maintain their remaining ICM supplies. This study sought to determine the impact of contrast shortage on the incidence of contrast-associated acute kidney injury (CA-AKI). Methods: This was a retrospective study of 265 patients undergoing 278 percutaneous coronary interventions (PCI) during 4-month periods prior to (9/1/2021 to 12/31/2021) and during (5/1/2022 to 8/31/2022) contrast shortage at a single center. The primary endpoint was the incidence of CA-AKI between study periods. Results: A total of 148 and 130 PCIs were performed before and during contrast shortage, respectively. The incidence of CA-AKI significantly decreased from 11.5% to 4.6% during contrast shortage (P = 0.04). During the shortage, average contrast volume per PCI was significantly lower (123 ± 62 mL vs 88 ± 46 mL, P < 0.001), while coronary imaging was significantly higher (34.3% vs 50%, P = 0.009) compared to preshortage. All-cause mortality at discharge was comparable between study periods (2.8% vs 3.3%, respectively; P = 0.90). Conclusion: The scarcity of ICM for PCI procedures in this single-center experience was associated with a significant increase in the utilization of intravascular imaging and a significant reduction in CA-AKI.

Moderna COVID-19 Vaccine: A New Player in Vaccine-Induced Thrombosis Without Thrombocytopenia.

This is a case of a 31-year-old male with no past medical history who developed extensive pulmonary embolism (PE) and deep venous thrombosis (DVT) three days after receiving the second dose of the Moderna vaccine. The patient presented with left calf swelling and mild shortness of breath, with no fever or hemodynamic instability. Doppler ultrasound of the left lower extremity showed thrombus in the common femoral, superior, mid-, and distal femoral, popliteal, and posterior tibial veins. Chest CT angiography (CTA) visualized extensive pulmonary emboli in the bilateral main pulmonary, lobar, and segmental arteries. Comprehensive hypercoagulable workup was unrevealing. The leading diagnosis was postulated as vaccine-induced thrombosis (VIT). Due to the diagnosis of bilateral sub-massive PE, the patient was initiated on enoxaparin and continued on direct-acting oral anticoagulation for at least one year. Our report showcases a plausible link between the Moderna vaccine and thrombosis due to the extensive and unprovoked nature of DVT/PE in this patient with a negative hypercoagulable workup. Although the mechanisms behind the messenger ribonucleic acid (mRNA) and double-stranded deoxyribonucleic acid (dsDNA) vaccines vary, the possibility of vaccine-induced thrombosis (VIT) after the Moderna vaccine is highly probable. Vaccine-induced thrombosis should be considered in a patient presenting with unprovoked thrombosis after the Moderna COVID-19 vaccine, and further research needs to be conducted to ascertain the correlation. However, these findings should not dissuade the use of the Moderna vaccine given its proven benefits.

A Review of the Impact of Sun Safety Interventions in Children.

INTRODUCTION: In the United States, melanoma and non-melanoma skin cancers comprise the largest proportion of new cancer diagnoses every year. The prevalence of skin cancer can be largely reduced if proper preventative behaviors are adopted at an early age. OBJECTIVES: We assessed the impact of various informational, economic, and environmental interventions on sun-protective behaviors, knowledge, attitudes, and sun exposure in the pediatric population reported in previous studies. METHODS: A systematic search for relevant articles was conducted using three databases. Studies were included if they met the following three criteria: study subjects less than 18 years old, clear, measurable interventions and outcomes, and publication in the English language. RESULTS: A total of 66 studies were included, of which 48 resulted in positive behavioral changes (i.e. increases in sunscreen application, use of hats and sun-protective clothing, shade-seeking, and avoidance of outdoor activities during peak UV radiation), 28 resulted in increased knowledge, 2 resulted in changes in attitudes towards tanning, and 10 resulted in decreased sun exposure effects (i.e. new sunburns, number of new nevi, and change in pigmentation of the skin). CONCLUSIONS: It is crucial that children be educated on the importance and benefits of sun protection. Although a variety of interventions showed promise in achieving this goal, the challenges associated with adopting change were evident. This review provides direction for future interventions aimed at improving sun safety in children and illustrates the potential impact that early intervention can have on the incidence of skin cancer in future generations.

Addressing the effect of meteorological factors and agricultural subsidy on agricultural productivity in India: a roadmap toward environmental sustainability.

In the last two decades, the extensive literature that has measured agricultural productivity and growth rate remains controversial and provides few strategies about its main determinants. The present study aims to find out the key determinants of food grain yield (FGY) and examine the role of climate change and agricultural subsidy (SUB) in the context of India using annually data spanning from 1991 to 2018. The current study applied the ARDL modelling to investigate the impacts of climatic factors (average rainfall (RF), mean temperature (AT), and carbon emission (CO2) and agricultural subsidy (SUB) on food grain yield (FGY) in the short-and long-term in India. The estimated outcomes indicate that climatic factors such as RF have a positive impact while AT and CO2 have a negative effect on FGY. Similarly, non-climate variables such as gross capital formation (GCF) and fertilizer usage (FERT) positively contributed to FGY, while the area under crop (LUC), SUB, and employment (AL) negatively affected FGY in India. The results from Granger causality divulge that climatic and non-climatic elements are the main determinants of food grain yield, which have been playing play a significant role in enhancing food grain production and ensuring food security in India. Based on empirical outcomes and findings, some key policy implications emerged. Precisely, government and policy developers should focus on technological innovation and precision agriculture to increase agriculture production and productivity. Government should create funds to curb the climate change problem and promote eco-friendly renewable energy.

Digital photography for the dermatologist.

Dermatology is a specialty reliant on presenting detailed and accurate visual observations. Digital photography is a highly prevalent and accessible technology that can be easily incorporated into a dermatology practice to facilitate documentation and communication of clinical findings. Dermatologists will benefit from being comfortable with digital photography and techniques to improve their photography skills. This review presents the fundamentals of photography and techniques helpful in capturing an adequate image. We explore the application of photography in the setting of microscopy, dermatopathology, dermatoscopy, and Wood's lamp. Lastly, new imaging technologies, such as multispectral and infrared imaging, are discussed.

How technological innovation and electricity consumption affect environmental quality? A road map towards achieving environmental sustainability.

Still the world witnessed an upturn in environmental degradation in spite of commitment to climate change across the nations. However, this study attempts to examine linkages among environmental degradation, technological innovation, and electricity consumption in India from 1981 to 2018 using time series data. To examine the long-run equilibrium relationship among the studied variables, we used robust econometric methods such as the autoregressive distributed lag (ARDL), fully modified ordinary least square (FMOLS), and dynamic ordinary least square (DOLS) methods. Furthermore, Granger causality also investigates through the vector error correction model (VECM) model, to assess inter-connotation among the underlying variables. From our empirical findings, urbanization, financial development, and technological innovation have a negative impact on carbon emissions, indicating long-term improvements in environmental quality. While economic development and electricity consumption are deteriorating environmental quality in India. The study's findings suggest that policymakers should prioritize renewable energy, which decreases environmental damage without impeding economic growth.

Impact of Silymarin Supplements on Liver Enzyme Levels: A Systematic Review.

Silymarin, extracted from milk thistle (Silybum marianum), is esteemed for its antioxidative, anti-inflammatory, and antifibrotic properties, notably within liver-related contexts. Nevertheless, a comprehensive grasp of its effects on liver enzymes remains elusive. This systematic review aims to scrutinize the influence of silymarin supplements on liver enzyme levels, elucidating its potential for hepatoprotection. Following PRISMA 2020 guidelines, we systematically reviewed pertinent studies in PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online). Our inclusion criteria comprised randomized clinical trials (RCTs) published between 1992 and 2023, accessible in English, with a primary focus on liver enzyme levels. Non-original research, ambiguously defined studies, and those lacking essential data were excluded. Of the 1,707 initially identified articles, 29 RCTs met the inclusion criteria, encompassing 3,846 participants with diverse underlying conditions. Silymarin dosages ranged from 140 mg to 420 mg, administered for various durations. Results revealed that 65.5% of the studies reported reduced liver enzyme levels, 20.7% exhibited no significant change, and 13.8% observed elevated liver enzymes. The systematic review implies a potential advantageous influence of silymarin on liver enzyme levels, indicating its hepatoprotective potential. Nevertheless, outcome disparities may stem from comorbidities, suboptimal doses, and underlying diseases. Notably, silymarin's impact on liver enzymes could be context-dependent, with varying responses among different conditions, with the decrease of liver enzyme levels in patients with non-alcoholic fatty liver disease. Silymarin supplements exhibit potential for hepatoprotection by ameliorating liver enzyme levels across diverse conditions. Further research should ascertain optimal dosages and contexts, accounting for individual patient characteristics and underlying diseases.

A Case of Perifollicular Macular Amyloidosis.

Macular amyloidosis is a common type of primary localized cutaneous amyloidosis. We present a case report of a 74-year-old patient with no significant past medical history who was evaluated for dark macules and pruritus for over a year. On exam, follicular-based brown macules on the upper and lower back, bilateral shoulders, and bilateral dorsal upper arms were noted. The morphology and distribution of follicular-based macules was unusual, so the differential included follicular lichen planus, follicular eczema, and macular amyloidosis. Punch biopsy showed deposits of eosinophilic fibrillary material along with pigmentary incontinence in the papillary dermis, consistent with macular amyloidosis. Additionally, there was some trapping of the adnexal structures with atrophy of the periadnexal fat in the reticular dermis. In macular amyloidosis keratin, intermediate filaments such as cytokeratin serve as the amyloid precursors which deposit in the superficial dermis. Characteristically, macular amyloidosis presents as hyperpigmented macules or patches, often in a "rippled" linear pattern. This case highlights a rare presentation of macular amyloidosis because of the atypical follicular involvement and emphasizes the variety of presentations for localized cutaneous amyloidosis. Additionally, new treatment options such as Janus Kinase inhibitors and their potential role in the pathological pathway are discussed.

IoT Based Expert System for Diabetes Diagnosis and Insulin Dosage Calculation.

High blood glucose levels are the defining characteristic of diabetes. Uncontrolled blood glucose levels in diabetic patients might result in mortality. As a result, there is a dire need to control blood glucose levels by constantly monitoring them and delivering the appropriate amount of insulin. However, insulin consumption is affected by several variables, including age, calorific intake, and body weight. The patient must see the doctor on a regular basis in order to determine the appropriate dose. Nonetheless, hospital facilities are finding it increasingly difficult to treat patients as the number of patients rises; thus, the healthcare industry is searching for an efficient method that can alleviate their burden by assisting patients with chronic conditions through remote patient care. In this work, we have developed an expert system to provide remote treatment for diabetic patients. Our expert system consists of two distinct components: one for the patient and one for the hospital. The sole requirement for the patient will be a wearable device that captures and transmits all relevant data to the cloud. On the hospital side, there should be a system in place to process that data in the cloud. The system employs a fuzzy system to handle data in two stages. A fuzzy system is initially employed to identify whether or not a patient is diabetic. In the second stage, a fuzzy system is utilized to determine the insulin dosage for a diabetic patient. Using sensors and the ESP8266 platform, we have developed a prototype of patient-side hardware. The MATLAB fuzzy toolbox is used for the processing part, which includes fuzzy systems, and the results of the MATLAB analysis are presented in the form of simulation results to demonstrate the accuracy of the proposed system in terms of determining insulin dosage. The results of the simulation using the fuzzy toolbox for the insulin dose of the diabetic patient are significantly close to the amount of dosage prescribed by the endocrinologist.

Assessing the long- and short-run asymmetrical effects of climate change on rice production: empirical evidence from India.

In recent years, environmental change has arisen as a ubiquitous problem and gained environmentalist's attention across the globe due to its long-term harmful effects on agricultural production, food supply, water supply, and livelihoods of rural households. The present study aims to explore the asymmetrical dynamic relationship between climate change and rice production with other explanatory variables. Based on the time series data of India, covering the period 1991-2018, the current study applied the nonlinear autoregressive distributed lag (NARDL) model and Granger causality approach. The results of the NARDL reveal that mean temperature negatively affects rice production in the long run while positively affecting it in the short run. Furthermore, positive shocks in rainfall and carbon emission have negative and significant impacts on rice production in the long and short run. In comparison, negative rainfall shocks significantly affect rice production in the long and short run. Wald test confirms the asymmetrical relationship between climate change and rice production. The Granger causality test shows feedback effect among mean temperature, decreasing rainfall, increasing carbon emission, and rice production. While no causal relationship between increasing temperature and decreasing carbon emission. Based on the empirical investigations, some critical policy implications emerged. Toward sustainable rice production in India, there is a need to improve irrigation infrastructure through increasing public investment and to develop climate-resilient seeds varieties to cope with climate change. Along with, at the district level government should provide proper training to farmers regarding the usage of pesticides, the proper amount of fertilizers, and irrigation systems.

Issues in Melanoma Detection: Semisupervised Deep Learning Algorithm Development via a Combination of Human and Artificial Intelligence.

BACKGROUND: Automatic skin lesion recognition has shown to be effective in increasing access to reliable dermatology evaluation; however, most existing algorithms rely solely on images. Many diagnostic rules, including the 3-point checklist, are not considered by artificial intelligence algorithms, which comprise human knowledge and reflect the diagnosis process of human experts. OBJECTIVE: In this paper, we aimed to develop a semisupervised model that can not only integrate the dermoscopic features and scoring rule from the 3-point checklist but also automate the feature-annotation process. METHODS: We first trained the semisupervised model on a small, annotated data set with disease and dermoscopic feature labels and tried to improve the classification accuracy by integrating the 3-point checklist using ranking loss function. We then used a large, unlabeled data set with only disease label to learn from the trained algorithm to automatically classify skin lesions and features. RESULTS: After adding the 3-point checklist to our model, its performance for melanoma classification improved from a mean of 0.8867 (SD 0.0191) to 0.8943 (SD 0.0115) under 5-fold cross-validation. The trained semisupervised model can automatically detect 3 dermoscopic features from the 3-point checklist, with best performances of 0.80 (area under the curve [AUC] 0.8380), 0.89 (AUC 0.9036), and 0.76 (AUC 0.8444), in some cases outperforming human annotators. CONCLUSIONS: Our proposed semisupervised learning framework can help with the automatic diagnosis of skin disease based on its ability to detect dermoscopic features and automate the label-annotation process. The framework can also help combine semantic knowledge with a computer algorithm to arrive at a more accurate and more interpretable diagnostic result, which can be applied to broader use cases.

Online dermatology curriculum experiences among US dermatology residents and faculty.

Many dermatology residency programs adapted to the COVID-19 pandemic by transitioning to online teaching methods. This may impact the quality of education and the satisfaction of residents. Dermatology faculty and residents nationwide were surveyed regarding their experiences with the novel online curricula. A total of 65 individuals representing at least 20 ACGME-accredited dermatology programs responded. Many programs implemented a predominantly online curriculum (78%). Most participants reported that both clinical dermatology and dermatopathology were online during the pandemic's peak (90%). Among those who had experienced a live curriculum prior to the pandemic, 49% reported that a virtual curriculum had similar effectiveness, whereas 36% deemed it less effective. Open-ended questions suggested that disadvantages of a virtual curricula included too many distractions, lack of human features, and less spontaneous feedback. They also suggested advantages to an online curriculum included flexibility and more opportunities to hear from guest speakers. Dissatisfaction before the curriculum change was the same as after (7%), suggesting that the educational experience was not worsened. Failing to adjust the curriculum to residents' needs can contribute to lower satisfaction and inadequate education. The variation of responses signifies the importance of seeking sufficient feedback from residents to meet their educational needs.