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Background: Clinically assisted nutrition and hydration via percutaneous endoscopic gastrostomy (PEG) is a therapeutic option to ameliorate the difficulties associated with enhanced catabolism, weight loss, and dysphagia in Huntington's disease (HD). Objectives: The objective is to provide insights into demographics, staging (Shoulson‐Fahn), complications, weight trajectories, and survival rates in people with HD (pwHD) who underwent PEG. Methods: This retrospective study included 705 consecutive pwHD who attended our HD clinic between July 2006 and March 2024, of whom 52 underwent PEG. A control group (n = 52), comprising pwHD without PEG, were closely matched for sex, stage, age, CAG length, and disease burden score at PEG. The study was registered as a service evaluation at the National Hospital for Neurology and Neurosurgery. Results: PEG prevalence was 15.0% (n = 52/347) among manifest pwHD: 4.8% (n = 3/62) for Stage 3; 33.3% (n = 16/48) for stage 4; and 44.1% (n = 30/68) for stage 5. Commonest indications were dysphagia, weight loss, and inadequate oral intake. Complications included chest infection, tube dislodgement, and peristomal and skin infections. Modeling of weight trajectories after PEG found no difference between PEG and non‐PEG groups. Mortality rate was 34.6% (n = 18/52) in the PEG and 36.5% (n = 19/52) in the non‐PEG groups (P = 0.84). Treatment duration (until study endpoint or death) was 3.48 years (interquartile range = 1.71–6.02; range = 0.23–18.8), with 65.4% (n = 34/52) alive at the study endpoint. Conclusion: PEG in pwHD at‐risk for weight loss may help slow weight loss. Prospective studies are required to strengthen PEG decision‐making in pwHD. PEG survival was much longer than other dementias, highlighting the need to consider PEG independently in pwHD. [ABSTRACT FROM AUTHOR]

Global Navigation Satellite System Interferometric Reflectometry (GNSS‐IR) measures water level using the interference pattern in signal‐to‐noise ratio (SNR) from direct and reflected signals off the sea surface, retrieved from standard geodetic antennas. Significant wave height is also measured by determining the satellite elevation angles where reflections become incoherent. We developed an approach for standard geodetic antennas to simultaneously measure sea levels and waves using a criterion for identifying coherent reflections. We tested the method at an exposed coastal environment at the E.B. Scripps Memorial Pier in California. The 1‐year test captures a broad range of sea states and benefits from several co‐located standard oceanographic sensors. By including GPS, Galileo, and GLONASS observations, the retrieval rate increases by a factor of ∼2 over GPS alone. Uncorrected water levels are estimated with a root‐mean‐square (RMS) error of 18.2 cm with respect to a conventional tide gauge. We further developed a simplified correction to remove the effect of phenomena altering the SNR oscillatory frequency and phase, which reduces RMS errors to 9.4 cm. We estimate the significant wave height with 15 cm RMS error with respect to a traditional wave gauge. The method, however, requires a short calibration. We find the wave height errors increase abruptly beyond a fixed limit when high waves are present, that may be a result of the particular deployment geometry. With this caveat, the technology could be useful to deploy in under‐sampled regions affected by compounded coastal hazards, such as in areas affected by tropical cyclones and flooding. Plain Language Summary: Signals from Global Navigation Satellite Systems (GNSS), such as the Global Positioning System (GPS), that reflect off the ocean surface, when compared to signals that arrive directly at the antenna, reveal variations in signal strength that can be used to determine the elevation of the ocean surface. When the satellite elevation angle is too high above the horizon, the method to measure sea level no longer works. However, observing the elevation angle where this transition occurs allows us to measure the height of the waves that are preventing a strong reflected signal from being recorded. We develop criteria for obtaining the closest agreement between the GNSS‐IR observations and the tide and wave gauge instruments on the Ellen Browning Scripps Memorial Pier in southern California over a 1 year period. Because it simultaneously measures changes in sea level and wave height, the method could be useful for measuring coastal hazards such as storm surge and flooding from hurricanes. Key Points: A new approach simultaneously estimates water level and wave height using Global Navigation Satellite System observations in the Pacific high wave coastal environmentLevels are determined with 9.4 cm error (RMS) and the astronomic tide (with a range over 2 m) is determined with 5.9 cm error, with respect to a traditional gaugeGiven a short calibration, significant wave height achieves an RMS error of 15 cm compared to a traditional gauge [ABSTRACT FROM AUTHOR]

Cytokine RNA in situ hybridization permits individualized molecular phenotyping in biopsies of psoriasis and atopic dermatitis. We describe a unique case of dupilumab-induced psoriasis in the setting of ICPi-associated dermatitis, characterized the immunologic cytokine profiles, and successfully treated ICPi-associated psoriasis with apremilast. Immune checkpoint inhibitors (ICPis) are associated with eczematous reactions that may be treated with dupilumab in corticosteroid-resistant cases.[1] There are also mounting reports of dupilumab triggering or exacerbating psoriasis when used for presumed atopic dermatitis.[2] Here we report a case of eczematous dermatitis associated with pembrolizumab therapy successfully treated with dupilumab that was followed by the development of psoriasis and characterize the cytokine profiles of biopsy specimens before and after dupilumab. [Extracted from the article]

A 60‐year‐old man with metastatic renal cell carcinoma presented with a 6‐month history of a pruritic, exquisitely painful genital eruption appearing 3 months after initiation of nivolumab. Examination demonstrated a poorly defined, lichenified scrotal plaque studded with erosions, yellow crust, and tense vesicles. There was no other lesion on the body or mucosae. Histopathology revealed a subepidermal blister with a mixed lymphocytic, neutrophilic, and eosinophilic infiltrate. Direct immunofluorescence of perilesional skin demonstrated subclinical blister and linear/fibrillary patchy IgG and IgA along the dermoepidermal junction. Bullous pemphigoid (BP) serologies revealed normal IgG BP230 antibodies and minimally elevated IgG BP180 antibodies. Indirect immunofluorescence revealed positive IgG at the basement membrane ("epidermal pattern") in human split skin and monkey esophagus substrates; no IgA antibodies were detected. The patient was diagnosed with nivolumab‐induced localized genital BP (LGBP). BP is a reported adverse effect of immune checkpoint inhibitors including nivolumab; however, cases are typically generalized. LGBP is a rare BP variant typically presenting in children and females; there are few reports of LGBP in adult males. We report a novel case of nivolumab‐induced LGBP with unique histopathologic and clinical challenges. LGBP should be considered in patients on immune checkpoint inhibitor therapy with bullous genital eruptions. [ABSTRACT FROM AUTHOR]

Landfalling atmospheric rivers (ARs) over the western US are responsible for ∼30%–50% of the annual precipitation, and their accurate forecasts are essential for aiding water management decisions and reducing flood risks. Sparse coverage of conventional observations over the Pacific Ocean, which can cause inadequate upstream initial conditions for numerical weather prediction models, may limit the improvement of forecast skill for these events. A targeted field program called AR Reconnaissance (Recon) was initiated in 2016 to better understand and reduce forecast errors of landfalling ARs at 1–5 days lead times. During the winter seasons of 2016, 2018, and 2019, 15 Intensive Observation Periods (IOPs) sampled the upstream conditions for landfalling ARs. This study evaluates the impact on forecast accuracy of assimilating these dropsonde data. Data denial experiments with (WithDROP) and without (NoDROP) dropsonde data were conducted using the Weather Research and Forecasting model with the Gridpoint Statistical Interpolation four‐dimensional ensemble variational system. Comparisons between the 15 paired NoDROP and WithDROP experiments demonstrate that AR Recon dropsondes reduced the root‐mean‐square error in integrated vapor transport (IVT) and inland precipitation for more than 70% of the IOPs, averaged over all forecast lead times from 1 to 6 days. Dropsondes have improved the spatial pattern of forecasts of IVT and precipitation in all 15 IOPs. Significant improvements in skill are found beyond the short range (1–2 days). IOP sequences (i.e., back‐to‐back IOPs every other day) show the most improvement of inland precipitation forecast skill. Plain Language Summary: Atmospheric rivers (ARs) are long and narrow corridors of water vapor transport in the atmosphere from the tropics to higher latitudes. Up to half of the annual precipitation in the western US states is related to landfalling ARs. Therefore, accurate forecasts of these events are important to reduce socio‐economic damage from the associated high‐impact weather and to better manage water resources over the western US. However, the forecast accuracy can be limited by sparse observations upstream over the Pacific Ocean. To fill observation gaps and improve forecast skills, a weather reconnaissance mission called Atmospheric River Reconnaissance was initiated in 2016 to release dropsondes from aircraft in key upstream sensitive regions. This study assesses the value of these observations in improving the initial conditions and the forecast skill of a regional model operated at the Center for Western Weather and Water Extremes for near real‐time weather forecasts. We found that the use of these additional observations collected during 2016, 2018, and 2019 has a positive impact on reducing the forecast error of water vapor transport within the Northeastern Pacific domain and the inland precipitation skill over the western US. These observations have more impact in poorly forecasted cases. Key Points: Dropsondes have reduced the forecast error of water vapor transport over the Northeast Pacific with continuous improvement out to day 3Dropsondes overall improved the precipitation forecast over the US West Coast in 11 out of 15 Intensive Observation Periods (IOPs)IOP sequences (i.e., back‐to‐back IOPs every other day) have the most positive impact on improving the precipitation forecast skill [ABSTRACT FROM AUTHOR]

Fire is a major ecological driver in many Australian ecosystems, and large‐scale wildfires can impact on faunal assemblages at a landscape scale. Monitoring the response of the avian community and individual bird species following a 92 039 ha wildfire in the Pilliga Forest, in temperate inland south‐eastern Australia, showed an initial decline in species richness and changes in community composition, followed by gradual recovery. Recovery was not complete by the end of the seven‐year study. Eighteen species (including Speckled Warbler Chthonicola sagittata and Eastern Yellow Robin Eopsaltria australis) were identified as likely to be fire sensitive and nine species (including Australian Magpie Cracticus tibicen and Red‐capped Robin Petroica goodenovii) as likely to respond positively to fire at the time scale of this study. Another 11 species (including Dusky Woodswallow Artamus cyanopterus and Jacky Winter Microeca fascinans) appeared to favour burnt areas close to the fire edge. Guild‐level patterns included an overall negative response to fire by insectivores, granivores/frugivores and declining woodland birds and a positive response by predators. The avian community recovered more quickly at burnt sites close to (within 2 km of) the fire edge compared to more remote sites more than 4 km from unburnt habitat, suggesting that proximity to unburnt areas (and therefore fire extent) is likely to be a key consideration in understanding the post‐fire recovery of birds. [ABSTRACT FROM AUTHOR]

Key points: Optogenetics has emerged as a potential alternative to electrotherapy for treating heart rhythm disorders, but its applicability for terminating atrial arrhythmias remains largely unexplored. We used computational models reconstructed from clinical MRI scans of fibrotic patient atria to explore the feasibility of optogenetic termination of atrial tachycardia (AT), comparing two different illumination strategies: distributed vs. targeted. We show that targeted optogenetic stimulation based on automated, non‐invasive flow‐network analysis of patient‐specific re‐entry morphology may be a reliable approach for identifying the optimal illumination target in each individual (i.e. the critical AT isthmus). The above‐described approach yields very high success rates (up to 100%) and requires dramatically less input power than distributed illumination We conclude that simulations in patient‐specific models show that targeted light pulses lasting longer than the AT cycle length can efficiently and reliably terminate AT if the human atria can be successfully light‐sensitized via gene delivery of ChR2. Abstract: Optogenetics has emerged as a potential alternative to electrotherapy for treating arrhythmia, but feasibility studies have been limited to ventricular defibrillation via epicardial light application. Here, we assess the efficacy of optogenetic atrial tachycardia (AT) termination in human hearts using a strategy that targets for illumination specific regions identified in an automated manner. In three patient‐specific models reconstructed from late gadolinium‐enhanced MRI scans, we simulated channelrhodopsin‐2 (ChR2) expression via gene delivery. In all three models, we attempted to terminate re‐entrant AT (induced via rapid pacing) via optogenetic stimulation. We compared two strategies: (1) distributed illumination of the endocardium by multi‐optrode grids (number of optrodes, Nopt = 64, 128, 256) and (2) targeted illumination of the critical isthmus, which was identified via analysis of simulated activation patterns using an algorithm based on flow networks. The illuminated area and input power were smaller for the targeted approach (19–57.8 mm2; 0.6–1.8 W) compared to the sparsest distributed arrays (Nopt = 64; 124.9 ± 6.3 mm2; 3.9 ± 0.2 W). AT termination rates for distributed illumination were low, ranging from <5% for short pulses (1/10 ms long) to ∼20% for longer stimuli (100/1000 ms). When we attempted to terminate the same AT episodes with targeted illumination, outcomes were similar for short pulses (1/10 ms long: 0% success) but improved for longer stimuli (100 ms: 54% success; 1000 ms: 90% success). We conclude that simulations in patient‐specific models show that light pulses lasting longer than the AT cycle length can efficiently and reliably terminate AT in atria light‐sensitized via gene delivery. We show that targeted optogenetic stimulation based on analysis of AT morphology may be a reliable approach for defibrillation and requires less power than distributed illumination. [ABSTRACT FROM AUTHOR]

Continuing technological advances are inevitably impacting the study and practice of dermatopathology (DP). We are seeing the transition from glass slide microscopy to virtual microscopy, which is serving both as an accessible educational medium for medical students, residents and fellows in the form of online databases and atlases, as well as a research tool to better inform us regarding the development of visual diagnostic expertise. Expansion in mobile technology is simplifying slide image attainment and providing greater opportunities for phone- and tablet-based microscopy, including teledermatopathology instruction and consultation in resource-poor areas with lack of specialists. Easily accessible mobile and computer-based applications ('apps'), including myDermPath and Clearpath, are providing an interactive medium for DP instruction. The Internet and social networking sites are enabling rapid global communication of DP information and image-sharing, promoting collaborative diagnostic research and scholastic endeavors. [ABSTRACT FROM AUTHOR]

Background Results of molecular studies are redefining the diagnosis and management of a wide range of skin disorders. Dermatology training programs maintain a relative gap in relevant teaching. Objective To develop a curriculum in molecular diagnostics, genomics and personalized medicine for dermatology trainees at our institution. The aim is to provide trainees with a specialty-appropriate, working knowledge in clinical molecular dermatology. Methods The Departments of Dermatology and Pathology and Laboratory Medicine collaborated on the design and implementation of educational objectives and teaching modalities for the new curriculum. Results A multidisciplinary curriculum was developed. It comprises: (i) assigned reading from the medical literature and reference textbook; (ii) review of teaching sets; (iii) two 1 hour lectures; (iv) trainee presentations; (v) 1-week rotation in a clinical molecular pathology and cytogenetics laboratory; and (vi) assessments and feedback. Residents who participated in the curriculum to date have found the experience to be of value. Conclusions Our curriculum provides a framework for other dermatology residency programs to develop their own specific approach to molecular diagnostics education. Such training will provide a foundation for lifelong learning as molecular testing evolves and becomes integral to the practice of dermatology. [ABSTRACT FROM AUTHOR]

The histopathologic features and immunohistochemical results supported the diagnosis of cutaneous metastasis of the patient's known breast carcinoma with variant CK20+/CK7- immunophenotype. CK20-positive/CK7-negative metastatic breast carcinoma to the skin 6 Tot T. The role of cytokeratins 20 and 7 and estrogen receptor analysis in separation of metastatic lobular carcinoma of the breast and metastatic signet ring cell carcinoma of the gastrointestinal tract. [Extracted from the article]

The structures and the electrochemical and spectral properties of a series of discrete [PPh4][MnN(CN)3(diimine)] complexes {diimine = 2,2′-bipyridine [ 1(bpy)], 4,4′-dimethyl-2,2′-bipyridine [ 1(4-dmbpy)], 5,5′-dimethyl-2,2′-bipyridine [ 1(5-dmbpy)], 1,10-phenanthroline [1(phen)] and bipyrimidine [ 1(bpym)]} have been assessed. These complexes represent potential building blocks for the construction of coordination frameworks. The incorporation of diimine ligands with different π-accepting capacities allows the systematic tuning of the metal-to-ligand charge-transfer (MLCT) band as well as the MnV/MnVI redox potential. The complexes exhibit solvatochromism, and the marked sensitivity of λmax of the MLCT band to polar solvents leads the way towards their potential application in chemical sensing. [ABSTRACT FROM AUTHOR]

Background The clinical use of molecular diagnostics, genomics, and personalized medicine is increasing and improving rapidly over time. However, medical education incorporating the practical application of these techniques is lagging behind. Although instruction in these areas should be expanded upon and improved at all levels of training, residency provides a concentrated period of time in which to hone in on skills that are practically applicable to a trainee's specialty of choice. Although residencies in some fields, such as pathology, have begun to incorporate practical molecular diagnostics training, this area remains a relative gap in dermatology residency programs. Methods Herein, we advocate for the incorporation of training in molecular diagnostics and personalized medicine into dermatology residency programs and propose a basic curriculum template for how to begin approaching these topics. Results/Conclusions By incorporating molecular diagnostics into dermatology residency training, dermatologists have the opportunity to lead the way and actively shape the specialty's transition into the era of personalized medicine. [ABSTRACT FROM AUTHOR]

A novel experiment developed for researching the initial collapse of an aluminum shaped charge liner was designed, executed, and validated. The experiment evolved from the need to recover shocked liner material to enable the analysis of relationships between microstructure and early liner collapse behavior. The research required material that had been shocked, yet was sufficiently intact to allow for metallurgical examination. Additionally, the experiment was designed to replicate the unique shock loading of shaped charge liners. Practically, the experiment had to be inexpensive to perform. The paper describes the experimental design, execution and validation and presents practical examples of the utility of the output. The experimental design is based on recreating a unique shock front, halting the deformation within a few microseconds and recovering material suitable for examination. Validation of the experiment employs a combination of available hydrocode modeling data and shaped charge liner collapse theory. The data collection supporting the validation was performed with computed tomography (CT) and laser generated 3D imagery. The output is recovered material valid for study. [ABSTRACT FROM AUTHOR]

Granulomatous pigmented purpuric dermatoses (PPD) are rarely reported. We present a case of granulomatous PPD in a 7‐year‐old boy, one of only two pediatric cases with reported solitary disease. The pathogenesis of unilesional granulomatous PPD may be different from the more commonly described multifocal/widespread disease variant. [ABSTRACT FROM AUTHOR]

ABSTRACT Monthly accumulated precipitation over the tropical Panama Canal Watershed has the largest interannual variability in December, with the wettest month on record being December 2010. December accumulated precipitation over the watershed is found to vary with sea surface temperature ( SST) anomalies in both the tropical North Atlantic and equatorial Pacific oceans, but a considerably stronger relationship is found with the difference between these SST anomalies. The configuration of SST anomalies in these two ocean basins during December has a strong effect on the flux of low-level moisture over the Caribbean Sea, southern Central America, and the eastern Pacific Ocean through the modification of the Caribbean Low-Level Jet ( CLLJ) and the Chorro del Occidente Colombiano ( CHOCO) jet. Wet Decembers in the watershed are associated with cool (warm) SST anomalies in the tropical Pacific (North Atlantic), a weakening (strengthening) of the CLLJ ( CHOCO jet), and increased moisture convergence over and around Panama, with the opposite conditions associated with dry Decembers. The SST anomalies in these two ocean basins affect the distribution of daily precipitation during December differently, with SST anomalies in the Pacific (Atlantic) predominately associated with changes in the frequency of heavier (lighter) precipitation. The analysis shows that December 2010 followed the pattern of associations of wet Decembers but with the highest intensity of precipitation and CHOCO jet strength. [ABSTRACT FROM AUTHOR]

Molecular diagnostic strategies are gaining wider acceptance and use in dermatology and dermatopathology as more practitioners in this field develop an understanding of the principles and applications of genomic technologies. Molecular testing is facilitating more accurate diagnosis, staging, and prognostication, in addition to guiding the selection of appropriate treatment, monitoring of therapy, and identification of novel therapeutic targets, for a wide variety of skin diseases. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to the development of cutaneous granulomas (CG) in the previous issue.

Objective To describe mortality and disease-specific morbidities in patients with mild primary hyperparathyroidism (PHPT). Design Retrospective population-based observational study. Setting Tayside, Scotland, from 1997 to 2006. Participants Patients with mild PHPT were selected from a predefined PHPT cohort between 1997 and 2006. Main outcome measures Standardised mortality ratios (SMRs) were examined for all-cause mortality, as well as cardiovascular and cancer mortality. Standardised morbidity ratios and standardised incidence ratios were also calculated for eleven observed co-morbidities. Results In total, there were 1683 (69·1% female) patients identified with mild PHPT in Tayside. Patients were found to have an increased risk of all-cause mortality and cardiovascular mortality (SMR-all cause 2·62, 95% CI 2·39–2·86; SMR-cardiovascular 2·68, 95% CI 2·34–3·05). Patients with mild PHPT had a significantly increased risk of developing cardiovascular and cerebrovascular disease, renal dysfunction and fractures compared to the age- and sex-adjusted general population. Conclusions Mortality and morbidity were increased for patients with mild untreated PHPT, which is similar to more severe PHPT. [ABSTRACT FROM AUTHOR]

Objective To evaluate prevalence and incidence of diagnosed primary hyperparathyroidism (PHPT) in adults between 1997 and 2006 in Tayside, Scotland, UK. Design Population-based incidence and prevalence study. Patients All Tayside residents aged 20 years and over with an increased serum calcium level (> 2·55 mmol/l) between 1997 and 2006 were included as potential participants. Using a unique patient identifier, data-linkage enabled a data set of PHPT patients to be created from an algorithm of biochemistry records, nuclear scan records, histology records, hospital clinic letters and community based prescription records. Persons having tertiary hyperparathyroidism (14·0%) were also identified and were excluded. Outcome measures Age and sex adjusted incidence density and period prevalence were calculated for each year. Results We identified 2709 patients (70·8% female) diagnosed with PHPT by the end of 2006. The mean age of women (68 years SD = 14) was older than that of men (64 years SD = 15) at baseline. The prevalence of diagnosed PHPT in Tayside increased from 1·82 per 1000 population in 1997 to 6·72 per 1000 population in 2006 ( P < 0·001). Prevalence of PHPT is higher in females, and the female preponderance increases with age; the annual prevalence ratio between women and men is stable at around 2·5 each year. There was a 3–4-year cyclical incidence rate varying from 4·13 to 11·30 per 10 000 person-years. Conclusion We observed a general increase in the prevalence of diagnosed PHPT in Tayside, Scotland. The incidence of diagnosis is greater in females than in males and increases with age. The annual incidence followed an apparent cyclic curve during the study period. [ABSTRACT FROM AUTHOR]

Adiponectin, a hormone produced and secreted by adipocytes, is present in circulation in high circulating concentrations, suggesting an important physiological role. An indirect regulator of glucose metabolism, adiponectin increases insulin sensitivity, improves glucose tolerance and inhibits inflammation. Plasma adiponectin relates inversely to adiposity and, importantly, reflects the sequelae of accumulation of excess adiposity. The role of adiponectin in adults has been explored in detail. Studies in children are now available and, given the increasing rates of childhood obesity, it is important to establish the role of adiponectin in mediating insulin resistance and cardiovascular disease in this age group. This paper reviews the regulation of adiponectin, its effect on body mass, glucose metabolism and cardiovascular risk in infants, children and adolescents. It demonstrates clear links between adiponectin and features of the metabolic syndrome in obese children and adolescents. However, adiponectin's role as a predictor of metabolic dysfunction in healthy, normal-weight youngsters is less clear. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Statins reduce cholesterol concentrations and cardiovascular events in randomized clinical trials. • Much less is known about their impact in the setting of normal care. WHAT THIS STUDY ADDS • This is the first study to assess the effectiveness of lipid-lowering treatment in the general population. • We have also estimated the resultant impact on major vascular events. • We have examined the actual and potential impact of lipid-lowering treatment. AIMS To evaluate the impact of lipid-lowering treatment on cholesterol concentrations in the setting of normal care. METHODS This was a retrospective review of all cholesterol measurements made in Tayside, Scotland, between 1993 and 2002, linked to dispensed prescribing data for lipid-lowering drugs. It was conducted in the setting of normal care and included all patients who underwent cholesterol measurement. The main outcome measure was cholesterol concentration. RESULTS A total of 401 489 cholesterol measurements were made on 128 240 patients over the study period. Measurements were categorized as treated and untreated according to whether patients were exposed to lipid-lowering treatment at the time the total cholesterol concentration was measured. Those categorized as untreated fell by 0.86 mmol l−1 (13.9%) and those categorized as treated by 1.45 mmol l−1 (23.5%). The difference between baseline and follow-up cholesterol concentrations in intention-to-treat patients was 1.53 mmol l−1 (24%) in 2002. In the same year, mean cholesterol concentration was 4.71 mmol l−1 (a fall of 1.65 mmol l−1 or 25.9%) in patients judged to be taking their lipid-lowering medication, compared with 5.20 mmol l−1 (a fall of 1.16 mmol l−1 or 18.2%) in those judged not to be taking treatment. Cholesterol fell by 0.38 mmol l−1 (6.3%) in a cohort of never treated patients ( n = 33 679) between 1993 and 2002. CONCLUSIONS The impact of lipid-lowering drugs on population cholesterol concentrations in the setting of normal care was significant and comparable with the cholesterol reductions seen in the setting of major statin trials, despite a significant proportion of the population receiving low dose treatment. In those subjects judged to be taking their medication, the benefits achieved were substantial. The impact of nondrug factors is indicated by the fall in population cholesterol seen in the absence of lipid-lowering treatment. [ABSTRACT FROM AUTHOR]

Melanocytic tumors commonly show intranuclear pseudo-inclusions or cytoplasmic invaginations within the nuclei of melanocytes. However, true intranuclear inclusions have rarely been described in melanocytic nevus cells. Herein, we describe the histologic, immunohistochemical and ultrastructural features of an additional case of an intradermal melanocytic nevus with true intranuclear inclusions. [ABSTRACT FROM AUTHOR]

The article presents a study that addresses the utility of the construct of social interest as related to the behaviors of criminal offenders. In this study, the inclusion criteria for offenders were as follows: male, 18 to 40 years old, anticipated release to parole within 120 days of the study's initiation, reading competency at or above the sixth-grade level, and availability of sufficient offender background information to complete the demographic and criminal history questionnaire. Offender scores on the Sulliman Scale of Social Interest, developed by J.R. Sulliman, were examined along with demographic and criminal history predictors of parolee outcomes following release from a medium security correctional institution. And results indicates significant relationships between social interest scores and offender outcome as demonstrated by employment status, new felony arrests, and reincarceration status. The high rate of offender recidivism suggests the ongoing value of identifying or developing measures that can improve our ability to predict and positively influence criminal offender outcome.

Background: Acquired lymphedema of the genitalia is a rare childhood presentation and is more common in elderly individuals secondary to pelvic/abdomenal malignancy or its therapy or worldwide due to filariasis. Objective: Herein, we report a case of a healthy 11-year-old boy who presented with a 1-year history of chronic, asymptomatic scrotal and penile swelling. Biopsy revealed edema, lymphangiectases and peri- and intralymphatic sarcoidal type granulomas. This histologic pattern of granulomatous lymphangitis is most commonly associated with orofacial granulomatosis (granulomatous cheilitis and Melkersson-Rosenthal syndrome) and Crohn’s disease. Treatment with topical steroids and physical support has resulted in marked improvement. No systemic disease (Crohn’s disease) is evident 1 year later. Literature review revealed 44 cases of genital lymphedema with non-infectious granulomas. The majority of these young patients had Crohn’s disease, frequently with anal involvement and a minority, both with and without Crohn’s disease, had orofacial granulomatosis. Conclusions: Granulomatous lymphangitis should be considered in the differential diagnosis of chronic idiopathic swelling of the genitalia, particularly in younger individuals. Further clinical examination, additional laboratory studies and close follow-up for co-existing or subsequent development of Crohn’s disease should be performed. The overlap between granulomatous lymphangitis of the genitalia, Crohn’s disease and orofacial granulomatosis suggest that granulomatous lymphangitis of the genitalia may represent a forme fruste of Crohn’s disease. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Cutaneous (or “Metastatic”) Crohn disease (CCD) is a rare and underrecognized disease characterized by cutaneous granulomatous inflammation. We describe patient demographics, clinical characteristics, histology, and treatment of 89 pediatric cases of CCD, including 78 previously reported and 11 new cases seen at four academic institutions. We emphasize the efficacy of biologic mono‐ and dual therapy.PubMed identified cases using keywords including “metastatic Crohn disease” and “cutaneous Crohn disease”. Patients were identified by retrospective review of the electronic health record including histopathologic diagnosis consistent with CCD. Chart review collected demographic, clinical, and histologic data.Most pediatric patients with CCD are male 55% (49/89), present with edema (73/89, 82%) and erythema (47/89, 53%) of the genitals (33/49, 67%), and have intestinal Crohn disease (69/89, 78%). Oral corticosteroids (53/75, 71%) and metronidazole (29/75, 39%) are the most frequently prescribed medications. Of the 17 patients treated with tumor necrosis factor (TNF)‐blockade, 94% (16/17) had partial or total clearance. Ustekinumab resulted in clearance of cutaneous disease in two patients (2/3, 67%) and partial clearance in one patient (1/3, 33%). Two cases achieved total clearance with the use of dual biologic therapy defined as the use of two biologic therapies with differing mechanisms of action or the use of a biologic therapy and small molecule inhibitor.TNF blockade is an effective treatment for pediatric CCD, and interleukin‐12/23 inhibitors may be similarly effective. Consideration of dual biologic therapy may be useful in pediatric patients requiring discordant therapies for their intestinal and cutaneous CD. [ABSTRACT FROM AUTHOR]

This study examined the effects of objects, with and without social stimulus properties, on the behavior of children who arc severely retarded, and compared such effects with behavior under conditions of minimal stimulation. It was found that these children approach, contact, grasp and interact significantly less often with objects which possess social stimulus properties than with objects which possess no social qualities. These results are discussed in relation to the ongoing debate on the importance of relationships in the reduction of challenging behavior. It is concluded that while having access to close-bonded relationships may be necessary for the reduction of challenging behavior, in some cases at least, it may not be sufficient. [ABSTRACT FROM AUTHOR]

Collective bargaining places countervailing pressures on teaching. On the one hand, it gives teachers a greater voice in determining working conditions. Under collective bargaining, teachers have shortened their contract day and their teaching day, reduced non-teaching duties, limited class size, and gained preparation time. Teachers have also gained job protections and procedural guarantees. On the other hand, collective bargaining has led to more explicit regulation of teachers and teaching work. Thus teaching has become more rationalized. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 71-year-old man who was presented to his dermatologist with rapidly growing papules of recent onset on his right cheek. He had a history of classical mantle cell lymphoma (MCL) of the left tonsil, but no evidence of oral disease at present. It notes that the reactivity of CD10, a cell surface neutral endopeptidase, may be associated with other variant immunophenotypic features in MCL.

A letter to the editor is presented regarding the integration of molecular data into clinical decision making and becomes the standard of care for diseases.

A letter to the editor is presented in response to the article "Trisomy 8 in myeloid leukemia cutis confirmed by fluorescence in situ hybridization analysis," by M. Shvartsbeyn and colleagues in the 2012 issue.

A letter to the editor is presented in response to the article "Quantitative proteomic analysis of formalin-fixed, paraffin-embedded (FFPE) melanoma," by S. Byrum and colleague, published in a previous issue.

The article presents randomized comparison of virtual microscopy (VM) and glass microscopy among dermatology and pathology residents during a simulated in-training examination. It mentions that no examinee reported difficulty in use of the glass slides. It adds estimated costs to adopt VM and price of an Aperio digital slide scanner.

Opinion. Comments on the importance of the presence of fathers in the children's formative years in the United States. Link between the presence of fathers and the entry of men into the prison system; Behavior exhibited by fatherless children; Need to address the correlation between fatherlesness and imprisonment.