Biomarkers of treatment benefit with atezolizumab plus vemurafenib plus cobimetinib in BRAFV600 mutation-positive melanoma.

BACKGROUND: The phase III IMspire150 study (NCT02908672) demonstrated significantly improved progression-free survival (PFS) with atezolizumab, vemurafenib, and cobimetinib (atezolizumab group) versus placebo, vemurafenib, and cobimetinib (control group) in patients with BRAFV600-mutated advanced melanoma. We report exploratory biomarker analyses to optimize targeting of patients who are more likely to benefit from triplet combination therapy. PATIENTS AND METHODS: Five hundred fourteen patients were randomized to atezolizumab (n = 256) or control (n = 258). Outcomes were evaluated in subgroups defined by key biomarkers, including programmed death-ligand 1 (PD-L1) expression, lactate dehydrogenase (LDH) level, tumor mutational burden (TMB), and interferon-γ (IFN-γ) gene signature. Exploratory recursive partitioning analysis was then used to model associations between PFS and baseline covariates, including key biomarkers. RESULTS: PFS benefit for atezolizumab versus control was greater in patients with high TMB [≥10 mutations/Mb; hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.52-1.02; P = 0.067] versus low TMB (<10 mutations/Mb; HR 0.92; 95% CI 0.65-1.30; P = 0.64) and similar between patients with strong IFN-γ (≥median; HR 0.76; 95% CI 0.54-1.06) versus weak IFN-γ (

Valorization of agro-industrial wastes to produce hydrolytic enzymes by fungal solid-state fermentation.

Nowadays, significant amounts of agro-industrial wastes are discarded by industries; however, they represent interesting raw materials for the production of high-added value products. In this regard, orange peels (ORA) and exhausted sugar beet cossettes (ESBC) have turned out to be promising raw materials for hydrolytic enzymes production by solid state fermentation (SSF) and also a source of sugars which could be fermented to different high-added value products. The maximum activities of xylanase and exo-polygalacturonase (exo-PG) measured in the enzymatic extracts obtained after the SSF of ORA were 31,000 U·kg-1 and 17,600 U·kg-1, respectively; while for ESBC the maximum values reached were 35,000 U·kg-1 and 28,000 U·kg-1, respectively. The enzymatic extracts obtained in the SSF experiments were also employed for the hydrolysis of ORA and ESBC. Furthermore, it was found that extracts obtained from SSF of ORA, supplemented with commercial cellulase, were more efficient for the hydrolysis of ORA and ESBC than a commercial enzyme cocktail typically used for this purpose. In this case, maximum reducing sugars concentrations of 57 and 47 g·L-1 were measured after the enzymatic hydrolysis of ESBC and ORA, respectively.

Vemurafenib in patients with BRAFV600 mutation-positive metastatic melanoma: final overall survival results of the randomized BRIM-3 study.

BACKGROUND: The BRIM-3 trial showed improved progression-free survival (PFS) and overall survival (OS) for vemurafenib compared with dacarbazine in treatment-naive patients with BRAFV600 mutation-positive metastatic melanoma. We present final OS data from BRIM-3. PATIENTS AND METHODS: Patients were randomly assigned in a 1 : 1 ratio to receive vemurafenib (960 mg twice daily) or dacarbazine (1000 mg/m2 every 3 weeks). OS and PFS were co-primary end points. OS was assessed in the intention-to-treat population, with and without censoring of data for dacarbazine patients who crossed over to vemurafenib. RESULTS: Between 4 January 2010 and 16 December 2010, a total of 675 patients were randomized to vemurafenib (n = 337) or dacarbazine (n = 338, of whom 84 crossed over to vemurafenib). At the time of database lock (14 August 2015), median OS, censored at crossover, was significantly longer for vemurafenib than for dacarbazine {13.6 months [95% confidence interval (CI) 12.0-15.4] versus 9.7 months [95% CI 7.9-12.8; hazard ratio (HR) 0.81 [95% CI 0.67-0.98]; P = 0.03}, as was median OS without censoring at crossover [13.6 months (95% CI 12.0-15.4) versus 10.3 months (95% CI 9.1-12.8); HR 0.81 (95% CI 0.68-0.96); P = 0.01]. Kaplan-Meier estimates of OS rates for vemurafenib versus dacarbazine were 56% versus 46%, 30% versus 24%, 21% versus 19% and 17% versus 16% at 1, 2, 3 and 4 years, respectively. Overall, 173 of the 338 patients (51%) in the dacarbazine arm and 175 of the 337 (52%) of those in the vemurafenib arm received subsequent anticancer therapies, most commonly ipilimumab. Safety data were consistent with the primary analysis. CONCLUSIONS: Vemurafenib continues to be associated with improved median OS in the BRIM-3 trial after extended follow-up. OS curves converged after ≈3 years, likely as a result of crossover from dacarbazine to vemurafenib and receipt of subsequent anticancer therapies. CLINICALTRIALS.GOV: NCT01006980.

Dietary administration of l-carnitine during the fattening period of early feed restricted lambs modifies lipid metabolism and meat quality.

Early feed restriction of lambs promotes a permanent mitochondrial dysfunction that impairs ß-oxidation of fatty acids along the whole life. Therefore, dietary l-carnitine might help to improve the mitochondrial function of these lambs, thus modifying lipid metabolism and meat quality traits. In order to test this hypothesis an experiment was carried out with 22 Merino lambs that were subjected to an early feed restriction during the suckling period. Once weaned, the lambs were allocated to a control group (CTRL, n = 11) being fed ad libitum a complete pelleted diet during the fattening phase, whereas the second group (CARN, n = 11) received the same diet formulated with 3 g/kg of l-carnitine. Carcass characteristics were not affected (P > 0.05) by treatment. However, lambs fed l-carnitine showed higher amounts of intramuscular fat (26.5 vs. 33.6 g/kg fresh matter; P = 0.047) with a lower ratio between polyunsaturated and saturated fatty acids (0.425 vs 0.333; P = 0.023) and a higher atherogenic (0.507 vs 0.597; P < 0.001) and thrombogenic index (1.23 vs 1.42; P < 0.001). An increase in lightness (P < 0.05) and a tendency to improved oxidative stability in cooked meat (P = 0.066) were also observed in the CARN group. Consequently, dietary l-carnitine supplied during the fattening period of early feed restricted lambs modifies meat quality traits thus increasing lightness, oxidative stability and intramuscular fat content, but worsening the fatty acid profile.

Effects of the use of raw or cooked chickpeas and the sausage cooking time on the quality of a lamb-meat, olive-oil emulsion-type sausage.

Reformulation of cooked sausages using high-protein plant-based food such as chickpea as meat extenders and vegetable oils to replace animal fat can be a suitable approach to promote the consumption of smaller portions of meat. The pre-processing of chickpea and the sausage cooking intensity can potentially affect the quality of reformulated sausages. In this study, an emulsion-type sausage made with lamb meat, chickpea and olive oil was prepared in triplicate following three different formulations containing the same targeted levels of protein (8.9%), lipids (21.5%), and starch (2.9%): control sausage (CON; control, without chickpea), and raw (RCP) and cooked chickpea (CCP) sausages (both with 7% chickpea). Sausages were cooked at 85 °C for two heating times (40 min or 80 min) and were analysed for weight loss, emulsion stability, colour, texture, lipid oxidation and volatile composition. Compared to CON sausages, the use of raw chickpea reduced the elasticity and significantly increased lipid oxidation during the sausage-making process resulting in major changes in the volatile composition. The use of previously cooked chickpea, however, resulted in the sausages having greater cooking loss, hardness and chewiness than CON sausages, while there was no difference in lipid oxidation, and differences in volatile compounds were scarce. The reformulation with cooked chickpea could provide a sausage with more similarity to the CON sausage. The extended heating time of 80 min at 85 °C did not significantly affect the quality traits in either CON or reformulated sausages except for a higher cooking loss.

Safety and efficacy of cobimetinib plus atezolizumab in patients with solid tumors: a phase II, open-label, multicenter, multicohort study.

BACKGROUND: Although introduction of immune checkpoint inhibitors has revolutionized the treatment of cancer, their response rates are generally low. Preclinical and early phase clinical data suggest that MEK inhibition may sensitize tumors to immune checkpoint inhibitors by upregulating tumor antigen expression, programmed death-ligand 1 (PD-L1) expression, and tumor T-cell infiltration. We evaluated the efficacy and safety of cobimetinib plus atezolizumab in patients with advanced solid tumors in the open-label, multicohort phase II COTEST study. PATIENTS AND METHODS: This analysis of the COTEST trial included patients from cohorts 1-4 [1-3: anti-programmed cell death protein 1 (PD-1)/PD-L1 treatment-naive patients; 4: patients with disease progression on anti-PD-1/anti-PD-L1 treatment] who received cobimetinib 60 mg once daily for the first 21 days and intravenous infusions of atezolizumab 840 mg on days 1 and 15 of each 28-day cycle. Efficacy endpoints included objective response rate, overall survival, progression-free survival (PFS), and disease control rate. RESULTS: Overall, 77 patients were enrolled in cohorts 1-4 (78% male; median age 62.8 years). Objective response rate was 20% in cohort 1 [squamous cell carcinoma of the head and neck (SCCHN)], 30% in cohort 2 (urothelial carcinoma), and 18% in cohort 3 (renal cell carcinoma); there were no responders among 20 patients in cohort 4 (SCCHN). The disease control rates in cohorts 1-4 were 50%, 40%, 24%, and 25%, respectively. The median PFS was 5.5, 3.4, 3.4, and 3.6 months in cohorts 1-4, respectively, and the median overall survival was 16.8, 18.7, 21.7, and 7.7 months, respectively. Most adverse events were of grade 1/2 and were manageable. CONCLUSIONS: Cobimetinib plus atezolizumab had moderate activity in patients with anti-PD-1/PD-L1 treatment-naive SCCHN and urothelial carcinoma, and weak activity in anti-PD-1/PD-L1 treatment-naive renal cell carcinoma, and no activity in checkpoint inhibitor-treated patients.

Composition, yield, and functionality of reduced-fat Oaxaca cheese: effects of using skim milk or a dry milk protein concentrate.

The effect of adding either skim milk or a commercial dry milk protein concentrate (MPC) to whole milk on the composition, yield, and functional properties of Mexican Oaxaca cheese were investigated. Five batches of Oaxaca cheeses were produced. One batch (the control) was produced from whole milk containing 3.5% fat and 9% nonfat solids (SNF). Two batches were produced from milk standardized with skim milk to 2.7 and 1.8% fat, maintaining the SNF content at 9%. In the other 2 batches, an MPC (40% protein content) was used to standardize the milk to a SNF content of 10 and 11%, maintaining the milk fat content at 3.5%. The use of either skim milk or MPC caused a significant decrease in the fat percentage in cheese. The use of skim milk or MPC showed a nonsignificant tendency to lower total solids and fat recoveries in cheese. Actual, dry matter, and moisture-adjusted cheese yields significantly decreased with skim milk addition, but increased with MPC addition. However, normalized yields adjusted to milk fat and protein reference levels did not show significant differences between treatments. Considering skim milk-added and control cheeses, actual yield increased with cheese milk fat content at a rate of 1.34 kg/kg of fat (R=0.88). In addition, cheese milk fat and SNF:fat ratio proved to be strong individual predictors of cheese moisture-adjusted yield (r(2) ≈ 0.90). Taking into account the results obtained from control and MPC-added cheeses, a 2.0-kg cheese yield increase rate per kg of milk MPC protein was observed (R=0.89), with TS and SNF being the strongest predictors for moisture adjusted yield (r(2) ≈ 0.77). Reduced-fat Oaxaca cheese functionality differed from that of controls. In unmelted reduced-fat cheeses, hardness and springiness increased. In melted reduced-fat cheeses, meltability and free oil increased, but stretchability decreased. These changes were related to differences in cheese composition, mainly fat in dry matter and calcium in SNF.

Happiness: A Novel Outcome in Parkinson Studies?

In this viewpoint, we draw attention to using happiness in clinical studies as an interesting outcome that is highly relevant to patients with Parkinson's disease. Quality of life (QoL) is thus far commonly used as main outcome in clinical trials. Happiness is a part of QoL, but also represents a construct on its own. While QoL mainly consists of quality perceptions of different extrinsic aspects of life, such as the environment or performance, happiness entails the intrinsic quality of the subjective enjoyment of life. Around 70% of people rate happiness as the most important thing in life. Happiness can be a difficult construct to measure, but we argue that self-compassion and well-being could serve as reliable indicators for happiness. We expect that happiness as outcome could probe the true value of an intervention for a patient, well beyond what is captured by more traditional outcomes such as motor scores or the general concept of QoL, which better reflect external factors. Because of the apparent importance of happiness to many people, we recommend that this concept is used more widely as outcome measure in future clinical trials.

Grain grinding size of cereals in complete pelleted diets for growing lambs: Effects on animal performance, carcass and meat quality traits.

The main goal of the present study was to clarify the effects of different grinding particle size of grains (2-mm vs. 6-mm) included in complete pelleted diets (CPD) for fattening lambs on animal performance, carcass and meat quality. Twenty male merino lambs (14.8 kg; n = 10 per group) were fed the corresponding diet ad libitum and slaughtered when they reached 27 kg. No differences were observed in the feed conversion ratio or carcass characteristics. However, lambs fed coarser diets (6 mm) were more efficient with less residual feed intake (-14.0 vs. 15.4 g DM/animal/d; P < .05) than lambs fed the 2 mm CPD. Lambs fed the 6-mm CPD showed higher levels of intramuscular fat and saturated fatty acids. Consequently, increasing the particle size of the grains included in CPD allows for improving feed efficiency and intramuscular fat in fattening lambs.

Bootstrap parametric GB2 and bootstrap nonparametric distributions for studying shiga toxin-producing Escherichia coli strains growth rate variability.

Shiga toxin-producing Escherichia coli (VTEC) strains, including the serotype O157:H7, are considered foodborne pathogens. Transmission occurs through consumption of undercooked meat, unpasteurized dairy products, vegetables, or contaminated water. The variability of pathogenic and nonpathogenic E. coli strains growth parameters at different temperatures and in different media was studied. Bootstrap parametric (Generalized Beta of the Second Kind, GB2) or nonparametric models were used. GB2 estimations show increased growth rates and shortened lag times with increased temperature, as expected. Similar estimations were obtained using the nonparametric model. Parametric and nonparametric growth rate confidence intervals were wider with increased temperature; lag times confidence intervals were wider with decreased temperature. The nonparametric method gives similar confidence intervals to the parametric method, confirming its suitability for growth parameters estimation. The estimations obtained from nonpathogenic E. coli strains approximate distributions from pathogenic E. coli strains.

Assessment of the antioxidant effect of astaxanthin in fresh, frozen and cooked lamb patties.

Astaxanthin is a natural red carotene exerting a strong antioxidant action. The effect of this carotene on the oxidative stability of raw and cooked lamb patties was evaluated. Seven experimental treatments were included in this study depending on the antioxidants added, which are: no antioxidant added (control), 450 mg/kg of sodium metabisulphite, 500 mg/kg of sodium ascorbate, and 20 mg/kg, 40 mg/kg, 60 mg/kg and 80 mg/kg of astaxanthin. The raw patties were either refrigerated for up to 11 days or frozen for 3 months under aerobic conditions. Changes in thiobarbituric reactive substances (TBARS), instrumental colour, pH and Eh were determined in the refrigerated patties and TBARS in the frozen patties. Volatile compounds were determined in cooked patties and cholesterol oxides in both cooked and after cooking microwave reheated patties. The changes in TBARS of cooked patties during a four-day refrigerated storage were also studied. Compared to the control patties, the use of astaxanthin reduced the TBARS generation in a manner depending on the dose for both raw and cooked patties during storage (P < 0.05). Astaxanthin added at levels of 60 and/or 80 mg/kg showed a greater antioxidant effect than ascorbate and metabisulphite. The presence of astaxanthin, like that of ascorbate, decreased the oxysterols levels of cooked patties with regard to controls. The amount of volatiles released from the cooked patties was also reduced by astaxanthin. This effect was not observed for ascorbate or metabisulphite. Astaxanthin in lamb patties at levels of 60-80 mg/kg could improve raw and cooked lamb patty oxidative stability during refrigerated aerobic storage, protect their lipids against thermal degradation more than ascorbate and metabisulphite, and reduce oxysterols formation during cooking in a similar way to ascorbate.

Evaluation of the use of multiflora bee pollen on the volatile compounds and sensorial profile of Palomino fino and Riesling white young wines.

This study investigates the impact of bee pollen on volatile compounds, odour activity values and sensory profiles in Palomino fino and Riesling young white wines. Commercial bee pollen was added to grape must using six different doses (0 (control), 0.1, 0.25, 1, 5, 10 and 20g/L) and fermented under controlled conditions. Volatile compounds were determined with GC and GC-MS chromatography and sensorial analysis using a qualified panel of tasters. Bee pollen produces an increase in volatile compounds depending on the grape variety and the dose applied. It also increases the synthesis of higher alcohols, methanol, esters, acetaldehyde and terpenes, reducing alcohols and fatty acids. Wines with low doses (0.1 and 0.25g/L) showed the higher OAV values (fruity and floral) and scores in overall judgment for the sensory evaluation. High pollen doses decrease fruity character and could result in deviations affecting the sensorial quality.

Bayesian modeling of two- and three-species bacterial competition in milk.

Listeria monocytogenes is a well-known food-borne pathogen and is among the bacteria best adapted to grow at low temperatures. Psychrotrophic spoilage microorganisms present in milk and milk products are primarily in the genus Pseudomonas, and their numbers increase during cold storage leading to deterioration and/or spoilage. The nature of the competition in two- or three-species bacterial systems with L. monocytogenes, L. innocua, and P. fluorescens in skimmed milk at 7 or 14°C was studied. The Baranyi growth model was used to estimate the growth rate and the maximum population density of the three microorganisms for each strain in single cultures or in two- or three-strains co-cultures. The highest Listeria populations were achieved by pure cultures, decreasing in co-culture with P. fluorescens at both temperatures. A modified deterministic logistic model was applied which includes inhibition functions for single cultures, and two- or three-species cultures. A subsequent Bayesian approach was applied for modelling the bacterial interactions. There was not a direct correlation between the growth rate of P. fluorescens and its inhibitory effect on Listeria species. The use of some species from the natural food microflora to inhibit pathogen growth may be an important tool to enhance the safety of refrigerated foods such as milk and dairy products.

Carcass and meat quality characteristics of Churra and Assaf suckling lambs.

Suckling lamb meat is traditionally produced in Mediterranean Europe. Breed can affect the quality of the lamb carcass and meat. This study is aimed at comparing the carcass and meat quality between suckling lambs from a local and a non-native dairy breed, Churra and Assaf. Churra is included in the Spanish Protected Geographical Indication (PGI) 'Lechazo de Castilla y León', whereas Assaf is not. However, Assaf breeders have requested the inclusion of the breed in the PGI. Carcasses and meat from 16 male lambs (eight Churra and eight Assaf) were used in this study. The lambs were all raised under an intensive rearing system and fed on a milk substitute to minimise maternal influence. The carcasses were evaluated for conformation, fatness, joint and leg tissue proportions and the meat was analysed for composition (i.e. proximate composition, iron, haematin, fatty acids and volatiles) and technological quality traits (i.e. texture, water holding capacity, colour and lipid stability). Churra carcasses were larger than Assaf carcasses. However, the proportions of commercial joints and main tissues did not differ between breeds. Cavity and intermuscular leg fat, but not total leg fat, were higher in Churra carcasses. Churra meat showed a higher proportion of n-6 fatty acids, higher redness and better colour stability during aerobic storage. In contrast, Assaf lamb was more resistant to lipid oxidation after cooking. This is a preliminary study to measure the influence of breed on a wide range of quality characteristics in Churra and Assaf suckling lamb carcass and meat. It may be of relevance for breeders, consumers and food policy makers, setting the basis for future studies that include larger commercial populations.

Valorization of exhausted sugar beet cossettes by successive hydrolysis and two fermentations for the production of bio-products.

Exhausted sugar beet cossettes (ESBC) show an enormous potential as a source of sugars for the production of bio-products. Enzyme hydrolysis with the combined effect of mainly cellulases, xylanases and pectinases, turned out to be very efficient, obtaining almost double the concentration of sugars measured with the sole action of Celluclast® and ß-glucosidase, and increasing 5 times the hydrolysis rate. As the sole pretreatment, ESBC soaked in the hydrolysis buffer were autoclaved, avoiding the application of severe conventional biomass pretreatments. Moreover, a promising alternative for the complete utilization of glucose, xylose, arabinose, mannose and maltose contained in ESBC is proposed in this paper. It consists of sequential fermentation of sugars released in the hydrolysis step to produce bioethanol and lactic acid as main bio-products. Compared to separate fermentations, with this strategy glucose and hemicellulose derived sugars were completely consumed and the 44% of pectin derived sugars.

[The pediatrician and child death: integration of palliative care in the pediatric intensive care unit]. / El pediatra ante la muerte del niño: integración de los cuidados paliativos en la unidad de cuidados intensivos pediátricos.

Palliative care is essential in the pediatric intensive care unit (PICU). Because of the mortality rates and the presence of life-threatening conditions in children admitted to the PICU, pediatricians must be prepared to provide palliative care independently of cure-directed therapies. The present article reviews certain issues, including the decision-making process in the PICU, psychosocial needs and susceptibility to burnout among PICU staff, and the emotions and attitudes of the staff when a child dies. We provide some guidelines on how to act when a child dies, how to meet with parents after the child's death and how to follow-up parental bereavement. Strategies that can help PICU pediatricians to cope with the numerous loses they experience are suggested.

Prevalence of renal stones in Andalusian population: results of PreLiRenA study.

INTRODUCTION: Urolithiasis is a disease having a high recurrence rate and associated morbidity. A not well quantified increase is being seen in recent years that could be related with various factors. The main purpose of our study has been to estimate urolithiasis prevalence and incidence in the region of Andalusia, determining which factors are associated. MATERIAL AND METHODS: We performed an observational and cross-sectional study. Using a multistage randomized procedure, we selected a sample of 2439 subjects, aging from 40 to 65 years old, who currently lived in Andalusia. Data was collected through phone interviews, questioning the chosen subjects about their kidney stones history, comorbidity and socio-demographic characteristics. We conducted a descriptive, bivariate and multivariate analysis with logistic regression. RESULTS: A total of 2439 subjects were surveyed. Subjects had mean age of 51.1±7.61 years - standard deviation; (95% confidence interval - 95% CI: 50.70-51.30), 48.7% of whom were male. Prevalence of urolithiasis obtained was 16.4% (95% CI: 14.87-17.85%) and an incidence of 1.2 (95% CI: .74-1.64). Variables significantly associated with the presence of urolithiasis found in the multivariate study were: presence of a family history of kidney stones (odds ratio -OR: 1.91; 95% CI: 1.51-2.40, P<.001), hypertension (OR:1.58; 95% CI:1.24-2.02; P<.001), gout (OR:1.98; 95% CI: 1.26-3,12; P=.003) and a high BMI (OR: 1.60; 95% CI 1.19-2.17; p=.008). CONCLUSIONS: A significant increase in the prevalence and incidence of urolithiasis is observed in the environment in regards to the previously available figures. The presence of a family history of urolithiasis, hypertension, gout as well as having a high BMI could influence the observed epidemiological changes in renal lithiasis.

Shortage of full-time faculty in dermatology.

A persistent shortage of full-time faculty exists in dermatology. Despite the addition of 124 new full-time faculty since 1971 through 1972, 136 training programs in 1974 through 1975 were actively seeking 88 new full-time faculty and believed they needed 243. With a net gain of 30 new faculty a year, it will take 2.93 years to add 88 new faculty that are being actively sought and 5.16 years to add 155 more that are urgently needed. During this eight years, demand for new faculty will increase, so that figures of need may remain essentially unchanged in 1982 through 1983 and between 1971 through 1972 and 1974 through 1975. Expertise that was most needed was in immunology, electron microscopy, histopathology, microbiology, and biochemistry; many accept faculty in any area or with no special training. Measures should be taken to attract and retain more dermatologists in full-time academic positions.

Intrauterine herpes simplex infections.

Most dermatologists are familiar with the manifestations of neonatal herpes simplex infections. Few, however, are acquainted with the concept of intrauterine herpes simplex infections. This article describes two additional cases of intrauterine herpes simplex infections with congenital malformations. Common features included intrauterine growth retardation, microcephaly, encephalitis, chorioretinitis, psychomotor retardation, and recurrent, grouped, cutaneous vesicles. Seven similar cases with congenital malformations are reviewed as well as cases of intrauterine herpes simplex infection without congenital malformations. We propose that intrauterine herpes simplex infections be termed "early" when there is evidence of disturbed embryogenesis or "late" when congenital malformations are less specific or inapparent. We further suggest that the spectrum of intrauterine infections is similar to that of neonatally acquired infections.

Secondary cutaneous mucinosis with systemic lupus erythematosus. A case presentation and review of the literature.

A patient had papular and nodular cutaneous deposits of mucin and cutaneous and systemic manifestations of lupus erythematosus (LE). Since many of the mucinous deposits occurred at sites that were clinically free of skin lesions of LE, we considered initially that the patient had both LE and papular mucinosis. However, after a review of the English literature and further study of the patient, it seemed more likely that the papular and nodular deposits of mucin were secondary to LE and not a previously unreported simultaneous occurrence of the two diseases in the same patient. To our knowledge, this is the third case report of a patient with papular and nodular cutaneous mucinosis secondary to LE. In addition to the case report, this article is concerned with a discussion of cutaneous mucinosis in LE and other "collagen vascular" diseases.