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Abstract Generalized pustular psoriasis (GPP) is a rare, chronic and potentially life-threatening autoinflammatory skin disease characterized by widespread eruption of sterile pustules, with or without systemic inflammation. GPP can significantly reduce patients’ quality of life (QoL). Several therapeutic approaches have been described in the literature, but there is no consensus on optimal treatment. In this review, we summarize published literature on efficacy, safety and QoL outcomes associated with current treatment of GPP with both approved and non-approved products. Embase and MEDLINE databases were searched (1980–September 2023). A search protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on the PROSPERO database (CRD42021215437). Details on publication, population, intervention, efficacy, safety and QoL were captured and checked by independent reviewers. In total, 118 publications were included, with only 19% of publications reporting on the results of clinical trials. Treatment modalities reported for GPP included non-biologic systemic therapies such as retinoids, cyclosporine and methotrexate, topical agents, biologics and small molecules, among others. Results were highly heterogeneous and methodological quality was very low, with only the interleukin-36R inhibitor spesolimab reporting results from placebo-controlled randomized trials; based on this, spesolimab is now approved for GPP treatment in regions including the USA, Japan, China, the EU and several other countries. Some other biologics are approved exclusively in Japan and Taiwan for the treatment of GPP based on open-label studies with small patient numbers in lieu of double-blind studies. Non-standardization of clinical outcomes across studies remains a major hurdle in reaching a consensus on optimal treatment. However, recently trials have been conducted using well-defined, disease-specific endpoints to evaluate GPP-targeted treatments, which will hopefully advance patient care. In conclusion, this review highlights the need for prospective randomized studies with GPP-specific endpoints to determine the optimal treatment strategy.

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This article reported the first case of spondylitis due to pustulotic arthro‐osteitis that was successfully treated with anti‐IL‐23p19 antibody guselkumab in terms of improvement in imaging assessment in addition to that of clinical symptoms.

Abstract is missing (Short communication)

Abstract Spitz nevus is an important differential diagnosis of malignant melanoma, especially in young adults. This case provides a significant information about unusual dermoscopic features of adult Spitz nevus, which may reflect changes over the years.

Abstract is missing (Short communication)

Purpose: The purpose of the present study was to evaluate the dosimetric benefits of the irregular surface compensator (ISC) technique for whole breast radiotherapy compared with the field-in-field (FIF) technique. Materials and Methods: Radiotherapy was planned using both techniques in 50 breast cancer patients (25 left sided and 25 right sided). The Eclipse treatment planning system (Varian Medical Systems) was used for dose calculations. For the FIF technique, subfields were added to the main fields to reduce hot and cold regions; for the ISC technique, the fluence editor application was used to extend the optimal fluence. Planning target volume dose, dose homogeneity index (DHI), maximum dose, ipsilateral lung, and heart doses for the left breast irradiation and monitor unit (MU) counts required for treatment were compared between the two techniques. Results: Compared with the FIF technique, the ISC technique significantly decreased DHI values and volumes receiving >105% of the prescription dose, and increased volumes receiving >95% of the dose and MU count (P < 0.01 for all comparisons). For the heart and ipsilateral lung, the FIF technique significantly reduced volumes receiving >5 Gy compared with the ISC technique (P < 0.01); however, volumes receiving >10, 20, and 30 Gy and the values of a mean dose did not differ significantly between the techniques (P > 0.05). Conclusions: The ISC technique is preferred over the FIF technique.

Abstract is missing (Short communication)

In terms of software, “continuous development” of the software is the best quality assurance. Continuous development requires either the original developer to continue development, or the next generation of developers to take over the development. It has been noted that when the original developer has used “open source,” a development paradigm in which the source code is kept open to all, highly motivated and competent developers will participate in development. This makes it easier for a project to survive. However, at the same time, when the source code is opened to a broad audience a fork in the source code tends to occur. When this happens, those with a high level of competence and motivation abandon the development and go their separate ways. In such a situation, it is difficult for a project to survive. In the case of Denshin 8 go, a guardian for the source code was appointed, and the original developer and the guardians avoided this dilemma. Richard Stallman of the GNU project and Linus Torvalds of Linux project act as legitimate guardians to avoid fork.

Success in software development is not simply “a person” or “a team” succeeding in development, but rather the execution of a smooth “shift to the next-generation” of developers, who continuously upgrade a single software product over a long span of time. In this case, different generations of developers share the source code. This paper analyzes this process using “Denshin 8 go,” Japanese free software as one example. Initially, the original creator, Ishioka developed Denshin 8 go single-handed as closed source software and succeeded in motivating users through frequent upgrades. Several years after the initial release of Denshin 8 go Ishioka lagged behind in much needed upgrades, but one user group continued to use Denshin 8 go and was eager to improve the software. He disclosed the source code to the group, which in turn carried forward the process of development. As this case shows, the viewpoint that alternate generation of developers outside of a single company is caused by success in software development is known as “open source” software development. However, the reverse is not necessarily true. That is, simply becoming open source does not guarantee successful development.

It is difficult to identify easily adaptable software in its completed form. In its nature, the definition of “complete” is unclear. As a result, if one expects perfection in software, software products will never be released; the only alternative is to release software if it runs, and then gradually refine it over time. This results in the implicit conventional wisdom that the “continuous development” of the software is the best quality assurance. This paper looks at the highly capable Windows e-mail software called “Hidemaru Mail.” With current progress in IT, it is possible that the concept of software quality assurance can be applied to a broader array of products and services.

“Free” and “open source” are not requirements for successful software development. The argument that “early and frequent upgrades” are one indicator of successful software development does not imply the necessity of users updating the source code but the importance that they function as testers and debuggers. In the development of Japan’s non-open source, non-free shareware “Hidemaru Mail,” the users perform the functions of testers and debuggers. It is evident from the case of Hidemaru Mail that early and frequent upgrades are neither result nor performance indicators, but rather the way to intrinsically motivate users so that they can function as testers and debuggers. In actuality, the developer of Hidemaru Mail motivates users to submit requests and reports more often by meticulously responding to almost all users’ requests and reports and upgrading early and frequently. Existing studies are overly particular about whether the source code should be open, and lack the perspective of organizational theory about how developers should motivate users to function as testers and debuggers. While there is the definite possibility of motivating users through open source, this does not indicate that open source is a necessary condition. The necessary condition is to motivate as many users as possible to cooperate in the development. If this is accomplished, the development of software will succeed, regardless of it being free or open.

G. H. Hofstede (1980) Culture’s Consequences is a result of an extensive research on the international comparison of corporate culture in 40 countries through 1967 to 1973. Hofstede identified four dimensions of culture from the investigation data of IBM’s 40 subsidiaries. He developed four indices, but did not explicitly present the exact computation formulas for Individualism index and Masculinity index. This paper reproduces the formulas and proves how to conduct a factor analysis that Hofstede employed for development of these indices. Hereafter, supplementary analysis could be done using all four indices of Hofstede. Also a factor analysis could be done in Hofstede’s method.

Immune suppressed organ transplant recipients suffer increased morbidity and mortality from primary cutaneous SCC. We studied tumor microenvironment in transplant-associated SCC (TSCC), immune-competent SCC and normal skin by IHC, IF and RT-PCR on surgical discard. We determined T cell polarization in TSCC and SCC by intracellular cytokine staining of T cell crawl outs from human skin explants. We studied the effects of IL-22, an inducer of keratinocyte proliferation, on SCC proliferation in vitro. SCC and TSCC are both associated with significantly higher numbers of CD3(+) and CD8(+) T cells compared to normal skin. TSCC showed a higher proportion of Foxp3(+) T regs to CD8(+) T cells compared to SCC and a lower percentage of IFN-γ producing CD4(+) T cells. TSCC, however, had a higher percentage of IL-22 producing CD8(+) T cells compared to SCC. TSCC showed more diffuse Ki67 and IL-22 receptor (IL-22R) expression by IHC. IL-22 induced SCC proliferation in vitro despite serum starvation. Diminished cytotoxic T cell function in TSCC due to decreased CD8/T-reg ratio may permit tumor progression. Increased IL-22 and IL-22R expression could accelerate tumor growth in transplant patients. IL-22 may be an attractive candidate for targeted therapy of SCC without endangering allograft survival.