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Background: Melanoma and non-melanoma skin cancers (NMSC) are the overall most common type of malignancy. Despite this fact, the use of sunscreen as a primary preventative measure for skin cancer is not ubiquitous. Objective: To review the literature regarding efficacy and safety of sunscreens and to process and condense data into overarching principles to provide guidance to the general public and improve outcomes for melanoma NMSC. Methods: A systematic review of the literature pertaining to sunscreen efficacy in the primary prevention of melanoma and non-melanoma skin cancer, safety in humans and environmental impact was conducted. Following a thorough review of the literature, the Skin Cancer Prevention Working Group (SCPWG), an expert panel consisting of dermatologists with specialized training in melanoma and NMSC diagnosis and management, employed a modified Delphi technique to reach consensus over the development of statements regarding the current level of evidence for sunscreen efficacy and safety. Final statements were only adopted after achieving a supermajority vote >80%. Results: 96 articles were identified for further review and discussion. The SCPWG developed 7 consensus statements regarding the efficacy and safety of sunscreens and their role in the prevention of melanoma and NMSC. Conclusion: The proven benefits of primary skin cancer prevention outweigh the potential/hypothetical risks of sunscreen use, especially given insufficient real-world, prospective data for the discussed risks. As experts in skin health and skin cancer pathophysiology, the SCPWG believes dermatologists are uniquely qualified to lead future studies investigating sunscreen efficacy and safety and should counsel patients and the public on skin cancer primary prevention strategies.

Background: The 31-gene expression profile (31-GEP) test uses 31 genetic markers obtained from the initial biopsy of a melanoma to assess melanoma-specific survival and sentinel lymph node positivity. Objective: To assess the professional understanding, opinions, and clinical usage of the 31-GEP test by dermatologists. Methods: Data from 589 unique dermatologists were collected during 2 virtual, nation-wide dermatology conferences via an 18-question survey on practice demographics and their clinical use and opinion of the 31-GEP test. Results: Participants reported that integrating the 31-GEP test may benefit patients by increasing knowledge and understanding (72.5%), personalizing treatment options (58.8%), and easing uncertainty about the future (59.7%). Benefits of using the 31-GEP test included identifying true negative patients in high-risk populations (65.6%) as well as true positives in low-risk populations (70.6%).A majority of participants also noted that if a patient received a 31-GEP Class 2B result, they would escalate subsequent management even if the lesions were classified as T1 (61.4%) or AJCC8 Stage I (59.0%). 84.9% of participants were somewhat to very likely to use 31-GEP testing for patient management or recommend this test to a colleague. Limitations: Potential respondent-selection and recall bias. Conclusion: Dermatologists are increasingly integrating the 31-GEP test into their melanoma clinical management decisions. As the 31-GEP test becomes more prevalent in practice, patients may benefit from decreased anxiety and uncertainty from enhanced prognosis, decreased need for unwarranted procedures such as sentinel lymph node biopsy and optimized allocation of healthcare resources.

HIV-infected individuals are at higher risk of non-AIDS diseases associated with procoagulant status. Microparticles are elevated in disorders associated with thrombosis (e.g., cardiovascular diseases). We investigated the association between microparticle levels in untreated and treated HIV-infected subjects, and determined the association with immune status, viral replication, and duration of antiretroviral therapy.We included 144 HIV-infected subjects, including 123 on antiretroviral therapy (ART) and 21 before treatment initiation. A control group of 40 HIV-negative healthy adults matched for age and sex was used for comparison of microparticle levels. Treated subjects were divided into five groups depending on the period of antiretroviral exposure. Statistically significant differences were determined by Kruskal-Wallis test and ChiMicroparticle levels were significantly higher in treated and untreated HIV-infected subjects than in non-HIV-infected controls (P0.001). The microparticle level was similar between the groups on treatment (P=0.913). No association between the microparticle level and CD4+ count, CD4+/CD8+ ratio, number of HIV-1 RNA copies, or duration of exposure to antiretroviral treatment was observed.Increased levels of microparticles may be due to processes independent of viral replication and CD4+ cell count, and microparticle release might persist even during viral suppression by antiretroviral treatment. Elevated microparticle levels might occur in response to other triggers.

Introduction: The number-needed-to-biopsy (NNB) metric measures the efficiency of a clinician’s ability to accurately diagnose and recommend pigmented skin lesions (PSLs) for biopsy for suspected melanomas. Electrical impedance spectroscopy (EIS) is a non-invasive technique that measures differences in resistance between healthy and cancerous skin cells, intended as an aid to enhance diagnostic accuracy.Methods: Dermatology clinicians of three distinct groups (residents, physician assistants/nurse practitioners, and practicing dermatologists) were evaluated on their ability to accurately recommend suspect PSLs for biopsy before and after the integration of EIS data.Results: All three groups had a reduction in NNB after the inclusion of EIS. Instances of missed biopsies for malignant melanoma were significantly reduced with simultaneous significant reductions in unnecessary biopsies for benign lesions. There was a material improvement of biopsy selection for PSLs having clinically challenging features. EIS also greatly improved the diagnostic acumen of clinicians whose assessments were less accurate than their peers prior to EIS incorporation.Conclusions: The integration of EIS technology into the PSL biopsy decision was demonstrated to be effective in significantly enhancing clinician NNB and more accurate PSL biopsy selection.

Appendiceal mucocele is an obstructive dilatation of the appendix, which results from the filling of its lumen with mucus. This is a rare condition that is asymptomatic in half of the patients. Its severity depends on the cause of appendiceal dilatation. In a small percentage of cases, the dilated appendix ruptures, leading to the development of serious complication; this is termed as pseudomyxoma peritonei. Due to the possibility of malignant etiology of the mucocele, surgical resection remains an essential part of the treatment.

Background: Despite the clinical availability and widespread usage of diagnostic and prognostic gene expression profiles (GEP) for the management of melanoma, no recommendations for Appropriate Use Criteria (AUC) exist to guide their integration into clinical practice.Objective: To develop a set of consensus-based AUC recommendations for the use of GEP profiling technology in the diagnosis and management of melanoma in specifically-defined situations commonly encountered by the practicing dermatologist.Methods: A systematic Medline literature search was performed to identify all existing evidence pertinent to the clinical efficacy and utility of three melanoma GEP tests that met the inclusion criteria (validated in peer-reviewed literature, US governmentally approved, and currently widely used) for review. A modified Delphi technique was used to achieve consensus and standard SORT criteria were applied. An expert panel of nine dermatologists/dermatologic surgeons/dermatopathologists developed a set of 29 clinical scenarios for the appropriate use of GEP assays and reviewed the available literature to make evidence-based recommendations for each indication.Results: The 2-GEP assay for melanoma diagnosis received 1 B-strength and 6 C-strength recommendations. The 23-GEP diagnostic test received 1 A-strength, 3 B-strength, and 4 C-strength recommendations. The 31-GEP prognostic assay received 1 A-strength, 7 B-strength, and 6 C-strength recommendations.Conclusions: These AUC recommendations provide an evidence-based framework for the integration of melanoma GEP tests into clinical practice.

Melanoma is rapidly evolving because of advances in noninvasive diagnosis, targeted therapies, and improved prognostic methods. This article discusses what is new in melanoma risk factors, prevention, clinical management, and targeted treatment. The incidence continues to increase worldwide, whereas mortality is steadily improving. This trend reinforces the importance of dermatologists comprehensively understanding all aspects of melanoma. Further research is needed to continue making a material impact on outcomes for patients.

Key Clinical Message The diagnosis of primary malignant melanoma of the anorectum is extremely rare and carries a very poor prognosis. While it is the third most common site of a primary melanoma, it accounts for

Functional magnetic resonance imaging has decoded complex information about naturalistic stimuli using brain responses, but other non-invasive technologies have not achieved similar decoding capabilities. To evaluate feasibility of naturalistic visual decoding with diffuse optical tomography (DOT), a 6.5-mm-spaced optode grid was employed to decode which of four naturalistic, 90-second, audio-free movie clips was viewed by human subjects. Over 85% average decoding accuracy was achieved using a simple template-matching decoder, and this exceeded the accuracy from a sparser optode grid with 13-mm spacing. High-density DOT is therefore promising for more-complex neural decoding tasks in the future.

Background Neural decoding could be useful in many ways, from serving as a neuroscience research tool to providing a means of augmented communication for patients with neurological conditions. However, applications of decoding are currently constrained by the limitations of traditional neuroimaging modalities. Electrocorticography requires invasive neurosurgery, magnetic resonance imaging (MRI) is too cumbersome for uses like daily communication, and alternatives like functional near-infrared spectroscopy (fNIRS) offer poor image quality. High-density diffuse optical tomography (HD-DOT) is an emerging modality that uses denser optode arrays than fNIRS to combine logistical advantages of optical neuroimaging with enhanced image quality. Despite the resulting promise of HD-DOT for facilitating field applications of neuroimaging, decoding of brain activity as measured by HD-DOT has yet to be evaluated. Objective To assess the feasibility and performance of decoding with HD-DOT in visual cortex. Methods and Results To establish the feasibility of decoding at the single-trial level with HD-DOT, a template matching strategy was used to decode visual stimulus position. A receiver operating characteristic (ROC) analysis was used to quantify the sensitivity, specificity, and reproducibility of binary visual decoding. Mean areas under the curve (AUCs) greater than 0.97 across 10 imaging sessions in a highly sampled participant were observed. ROC analyses of decoding across 5 participants established both reproducibility in multiple individuals and the feasibility of inter-individual decoding (mean AUCs > 0.7), although decoding performance varied between individuals. Phase-encoded checkerboard stimuli were used to assess more complex, non-binary decoding with HD-DOT. Across 3 highly sampled participants, the phase of a 60° wide checkerboard wedge rotating 10° per second through 360° was decoded with a within-participant error of 25.8±24.7°. Decoding between participants was also feasible based on permutation-based significance testing. Conclusions Visual stimulus information can be decoded accurately, reproducibly, and across a range of detail (for both binary and non-binary outcomes) at the single-trial level (without needing to block-average test data) using HD-DOT data. These results lay the foundation for future studies of more complex decoding with HD-DOT and applications in clinical populations.

Although the most common presentation of cutaneous malignant melanoma is in the form of a localized primary tumor of the skin, systemic involvement (regional and/or distant metastases) is apparent at diagnosis in approximately 15% of cases [1]. It is important for the practicing clinician to have a thorough understanding of the epidemiology, pathophysiology, and treatment of melanoma, as endorsement of prevention strategies, proper screening regimens, and appropriate treatment of early stage disease all play a role in preventing the development of advanced disease. For patients who do present with systemic involvement, recent advances in molecular biology and immunology have led to novel therapeutic targets and resultant life-prolonging treatment options.

Introduction: Transanal total mesorectal excision (TaTME) is a relatively new approach in surgical treatment of rectal cancer. There are no clear indications when to choose this strategy. It is a technically demanding procedure for the surgeon with a long learning curve, which should also be taken into account in evaluation of this method. The results of both oncological and postoperative complications must be properly evaluated to explore the benefit of TaTME. The aim of this study is to assess the potential benefit of TaTME compared to other alternatives in middle and distal rectal tumors. Methods: Retrospective evaluation of patients undergoing TaTME procedure performed by one team of surgeons between October 2014 and June 2019. The authors analyzed demographic indicators of the group of patients, tumor characteristics, specimen quality, early postoperative complications and the possibility of stoma reversal. Results: A total of 93 patients underwent TaTME procedure for middle and distal rectal cancer. Mean BMI was 27.6 (4.8). T3 or T4 tumor was found in 73 (78.5%) patients, 68 (73.1%) patients had positive lymph nodes and 12 (12.9%) patients were treated for synchronous metastatic rectal cancer. Neoadjuvant therapy was used in 80 (86%) patients. Conversion to open laparotomy was necessary in one case (1%). Stapled anastomosis was performed in 37 (39.7%) cases, handsewn in 56 (60.2%). A positive circumferential resection margin (CRM) was found in 10 (10.7%) cases. Distal resection margin (DRM) was positive in 3 (3.2%) patients. Pathological analysis showed a complete mesorectum in 18 patients (19.4%), nearly complete in 39 (41.9%) and an incomplete mesorectum in 36 (38.7%). Complications in the first 30 days after primary surgery were observed in 38 (40.8%) patients, mainly for anastomotic leak (19 patients, 20.4%). Reoperation was required in 7 (7.5%) patients. Permanent colostomy had to be performed in 4 (4.3%) cases. No patient died after surgery. Conclusion: In a selected group of patients it is possible to perform resection using this approach with acceptable postoperative morbidity and quality of the specimen. We used TaTME procedure in patients expected to have difficult TME due to obesity, size and distal localization of tumor. The incidence of conversion to open surgery was very low. Further studies for long term oncological outcomes are needed.

Current gold standard neuroimaging tools lack either necessary temporal resolution (PET) or optimal safety due to contraindications (fMRI) for measuring the neural mechanisms underlying the effects of deep brain stimulation of the subthalamic nucleus (STN DBS) in Parkinson disease (PD). In this study, we validate the feasibility of High-Density Diffuse Optical Tomography (HD-DOT) for mapping the cortical activity of the PD patients with their STN DBS ON and OFF during auditory and visual tasks and during resting state.

High density diffuse optical tomography (HD-DOT) combines logistical advantages of fNIRS with enhanced image quality, validated extensively against fMRI in adults and neonates. However, HD-DOT is yet to be evaluated in preschool-age children. Here we present an HD-DOT system optimized for preschoolers, including a 128-source by 125-detector console, light-weight fiber optics, and an expanded field-of-view. We validated the system by mapping cortical activations during visual, auditory, and motor tasks in adults. We then imaged children while they watched movies, finding reproducible patterns of brain activity and showing that feature regressors can map functionally specific regions from movie-viewing data in preschoolers.

Introduction: The main cause of postoperative pain after abdominal surgery is the wound where laparotomy is made. Recently, laparoscopic procedures have become common in colorectal surgery. Although improving the tolerance of the surgery, postoperative pain management still remains a discussed problem. The use of an epidural catheter used to be generally recommended in the open surgery era; however, an ideal strategy for postoperative analgesic therapy after laparoscopy remains unclear. Reduced administration of opioid analgesic drugs after colorectal resection is a generally accepted goal. Preperitoneal catheter insertion for continuous local anaesthetic (LA) infusion in the wound after surgery is a simple alternative to other pain management methods. Methods: Retrospective analysis of analgotherapy outcomes in patients undergoing laparoscopic colorectal resection procedures, divided in three patient groups according to the type of analgesia: Group 1: use of a catheter for local wound infusion (KAT) n=73; group 2: epidural analgesia (EPI) n=23; and control group 3 with combined parenteral and subcutaneous analgesia (CON) n=66. The main objective of this study was to analyse postoperative pain and the consumption of opioid analgesics in the first three days from the surgery and the incidence of any complications related to the analgesic therapy. Results: Opioid consumption in KAT and EPI groups was significantly lower compared to CON in the first 72 hours from the surgery. The lowest postoperative pain was measured in the EPI group. Subjective perception of pain, measured using VAS, was not significantly different between the KAT and CON groups. In KAT patients, vomiting was statistically less frequent than in CON patients. There was no significantly different incidence of paralytic ileus in the KAT and CON groups and no paralytic ileus was observed in the EPI group. There was no increased incidence of SSI (surgical site infections) in the KAT group compared to the other groups. Conclusion: The use of the catheter was assessed as safe. Insertion and management of the catheter is unsophisticated, and we did not observe any complications in terms of application of the catheter or toxic side effects of the LA. The use of the catheter clearly reduced opioid administration in the postoperative period compared to the control group (CON) with combined parenteral and subcutaneous analgesics. The best pain control measured using the visual analog scale (VAS) was observed in the EPI group.

Early detection of melanoma continues to provide a diagnostic challenge for Dermatologists and other healthcare providers. Recently, there has been increased interest in the use of novel technology to aid in the detection of melanoma. We retrospectively compared the results of one such technology—electrical impedance spectroscopy (EIS)—to existing melanoma detection tools in 265 cases of malignant melanoma. Lesions were analyzed using EIS, the clinical ABCD rule, the ABCD dermoscopy rule, and the standard and weighted melanoma 7-point checklists. The proportion of false negative cases was calculated for each method. Overall, EIS produced a lower false negative rate (3.4%) than the clinical ABCD rule, ABCD dermoscopy, the 7-point checklist, and the weighted 7-point checklist (12.8%, 45.8%, 50.8%, and 39.3%, respectively). Additionally, there was a statistically significant, moderate correlation between EIS score and tumor staging (Spearman rho=0.32, p

Background. Survey instruments are valuable tools for research and provide insight into real-world practice and areas of knowledge deficits in ways that traditional observational studies and randomized trials cannot. Despite some experts espousing survey response rates ≥60% as valid, there is no consensus as to what an adequate response rate is for a scientific survey. Furthermore, little is known what effect the interaction of survey administration modality and response rate has on results. Objective. To compare the results of differing survey modalities (which typically feature different response rate ranges). Methods. A validated, 21-item survey assessing perceptions of, recommendations regarding, and usage of sunscreen was distributed to three samples of dermatologists using three different modalities: pen/paper via mail, online via email, and in real-time via an audience response system at a national conference. Results. Response rates varied widely by survey modality (30% mail, 9% email 95% live). However, dermatologists’ responses to individual survey questions were largely consistent across modalities, with a statistically significant difference seen for only three questions (recommending sunscreens based on cosmetic elegance, recommending sunscreens based on photostability, and recommending vitamin D supplementation as a means to avoid sun exposure. Conclusions. In this study evaluating dermatologists’ perceptions of, recommendations for, and personal use of sunscreen, survey results were largely consistent across three different modalities (mail, email, live) despite widely variable response rates, from 9% to 95%. These results suggest that when a scientific survey sample is representative of the target population, minimum response rate and survey modality appear to have negligible impact on results.

Background. The topical adhesive, 2-octyl cyanoacrylate, has been used as an alternative to sutures for closure of skin in a variety of surgical procedures. While potential benefits exist, reports of allergic contact dermatitis and exothermic reactions have been a barrier to widespread adoption by dermatologic surgeons. Objective. To describe our experience using a novel formulation of 2-octyl cyanoacrylate for skin closure after surgical excision of cutaneous lesions. Methods. We describe the results of 9 office-based dermatologic excisions in 8 patients utilizing a novel formulation of 2-octyl cyanoacrylate for skin closure. At two weeks of follow-up, all incisions were examined for cosmetic result and signs of infection as per the office’s standard of care. Results. At follow-up, there were no signs of infection. One wound demonstrated mild tissue hypertrophy, while another showed very minimal skin separation (< 1mm) that did not require reintervention. No incidences of contact dermatitis, application discomfort, or burns were noted. Patient satisfaction was high. Conclusion. A novel formulation of 2-octyl cyanoacrylate topical adhesive demonstrates feasibility as a potential alternative to the use of sutures for skin closure following dermatologic excisions. Larger studies are imperative to fully describe the outcomes associated with use of this new preparation.

No Abstract Available

Obesity is recognised as the most common multifactorial nutritional disorder of pet cats. Studies from several countries have indicated that between 11.5% and 63% of cats are overweight or obese. Breed, age, sex, reproductive status, the pet-owner relationship, owners' perceptions of their cats' body condition, type of diet, frequency of feeding, and environment have all been identified as potential risk factors for the development of obesity in cats. Obesity has significant implications for feline health and welfare as it has mechanical and metabolic effects and can predispose cats to conditions such as diabetes mellitus type 2, hepatic lipidosis, lameness, oral cavity disease, urinary tract disease, dermatological disease, and neoplasia. An important aspect of preventing and managing obesity is the evaluation of body condition to determine ideal body weight and to formulate an appropriate weight loss plan. Several methods have been developed for this purpose. This review uses recent scientific literature to discuss various aspects of feline obesity, including its prevalence, proposed risk factors, pathogenesis, associated conditions, and methods of assessment.

Canine atopic dermatitis (CAD) is a chronic allergic disease characterised by genetic predisposition. The exact pathogenesis of the disease is still not fully understood. Blood parameters, lymphocyte subpopulations, cytokines and other molecules involved in pro- and anti-inflammatory activities, and Th1/Th2 polarisation in peripheral blood were assessed in clinically healthy dogs and dogs with AD by haematological examination, flow cytometry and qRT-PCR. The group of diseased dogs was further divided into subgroups according to the severity of clinical signs expressed as CADESI-03 (canine atopic dermatitis extent and severity index) values. The group of dogs with CAD showed mild neutrophilia without general leucocytosis, reduced numbers of B-lymphocytes (P < 0.05), increased relative numbers of T-lymphocytes ( P < 0.01) decreased absolute numbers of double-positive lymphocytes ( P < 0.001) and NK cells (P < 0.05) as compared with healthy controls. The expression levels of IL-10 mRNA were significantly higher ( P < 0.05) in the group with CAD. Correlation with CADESI-03 was observed in expression levels of CCL3 ( P < 0.05), CCL5 (P < 0.05) and SOCS-3 mRNAs (P < 0.05). In conclusion, the disease stage investigated in the present study is characterised by a chronic inflammatory response.

Transmission of canine leishmaniosis (CanL) is described in three consecutive generations of female Boxers living in a non-endemic environment in the Czech Republic. Infection of the first generation female likely occurred during a breeding visit to Italy and the dog died with typical clinical signs of the disease but without definitive laboratory diagnosis. The second and third generation offsprings never left the Czech Republic, suffered from clinical CanL confirmed by polymerase chain reaction and serology, and were apparently infected by transplacental transmission. Persistence of CanL in the Czech Republic over 7 years with a suspected origin in an endemic region and progression of infection through subsequent generations in a non-endemic country exemplifies that this disease may establish itself also in areas where no obvious vectors are present.

There has been recent extensive controversy concerning potential environmental and health hazards of oxybenzone (also known as benzophenone-3 and Eusolex 4360). Although there has been widespread related media attention, there is little definitive scientific research supporting the associated concerns. Given these controversies, it is critical that dermatologists have a clear understanding of the underlying issues related to oxybenzone in order to effectively counsel their patients. The purpose of this article is to provide dermatologists with a framework for presenting this issue to patients. Within, we address questions such as: 1) Is oxybenzone the reason for coral bleaching? 2) Is there data to suggest that oxybenzone is harmful to humans? 3) Why is oxybenzone used in the majority of US sunscreens? and 4) Are there other potential problems with oxybenzone restrictions that could lead to more skin cancer in the future? After a careful review of the evidence, we conclude that, in our opinion, there is little definitive scientific research supporting the associated concerns and that before this evidence exists, given the benefits of oxybenzone-containing sunscreens in skin cancer prevention, this ban is premature. Banning an ingredient commonly used in most sunscreens may lead to confusion among consumers and have the untoward outcome of less sunscreen being used overall.

The process of aging is associated with anticipated cutaneous changes such as epidermal thinning, dehydration, loss of barrier function, and decreased extracellular matrix components. These physiologic changes translate to clinical findings such as atrophy, pigmentary changes, and wrinkling. Over the past century, the role of decreased circulating estrogens in the process of cutaneous aging has been elucidated. Estrogen replacement, both systemic and topical, has been shown to have positive effects on aging skin by promoting fibroblast proliferation and increasing collagen density. However, despite these positive effects on skin health and appearance, estrogens also display a wide-range of actions on various other systems. Even topical estrogen application can result in unwanted systemic effects. Research into alternative substances such as soft estrogens—synthetic, non-hormonal molecules that produce local, cutaneous estrogenic effects and are then metabolized to inactive compounds prior to being absorbed into the systemic circulation— suggests that estrogenic-like benefits on aging skin could be harnessed safely, while avoiding the potential pitfalls associated with estrogen use.

Coral diseases contribute to the decline of coral reefs globally and threaten the health and future of coral reef communities. Acute Montipora white syndrome (aMWS) is a tissue loss disease that has led to the mortality of hundreds of Montipora capitata colonies in Kāne‘ohe Bay, Hawai‘i in recent years. This study describes the analysis of coral-associated bacterial communities using high-throughput sequencing generated by the PacBio RSII platform. Samples from three health states of M. capitata (healthy, healthy-diseased and diseased) were collected during an ongoing aMWS outbreak and a non-outbreak period and the bacterial communities were identified to determine whether a shift in community structure had occurred between the two periods. The bacterial communities associated with outbreak and non-outbreak samples were significantly different, and one major driver was a high abundance of operational taxonomic units (OTUs) identified as Escherichia spp. in the outbreak sequences. In silico bacterial source tracking suggested this OTU was likely from sewage contamination of livestock, rather than human, origin. The most abundant coliform OTU was a culturable E. fergusonii isolate, strain OCN300, however, it did not induce disease signs on healthy M. capitata colonies when used in laboratory infection trials. In addition, screening of the sequencing output found that the most abundant OTUs corresponded to previously described M. capitata pathogens. The synergistic combination of known coral pathogens, sewage contaminants and other stressors, such as fluctuating seawater temperatures and bacterial pathogens, have the potential to escalate the deterioration of coral reef ecosystems.

BACKGROUND Insufficient understanding of sunscreen labeling terminology is a barrier to effective use. The Food and Drug Administration (FDA) issued the "final rule" on sunscreen labeling in 2011, in an effort to promote effective usage. However, relatively little is known about patient knowledge of sunscreen labeling terminology. This study assesses the sunscreen labeling knowledge of dermatology patients, with an emphasis on understanding of the FDA-mandated wording. METHODS A validated survey was administered to consecutive dermatology office patients. Respondents answered questions about sunscreen use practices, sunscreen knowledge, and demographics. To assess their sunscreen knowledge, they responded to questions on the concepts of sun protection factor, broad-spectrum, and waterproof. RESULTS A total of 334 patients completed surveys. Only 8.7% of patients correctly answered all three questions related to sunscreen labeling terminology. Patients with a personal history of skin cancer were more likely to answer more than half of the questions correctly (P = 0.004). Older persons and those with darker skin types were most likely to answer all questions incorrectly. CONCLUSION General understanding of sunscreen labeling was poor, and a minority of consumers comprehended the key features of sunscreen labeling. This knowledge gap appeared to be slightly smaller in the subpopulation of patients with a personal history of skin cancer.

BACKGROUND Accuracy of US cancer statistics depends on physicians' knowledge of and adherence to reporting mandates. Significant knowledge and practice gaps have been documented in regards to melanoma reporting requirements. OBJECTIVE To determine whether the gaps in dermatologists' knowledge and practice of melanoma reporting persist. MATERIALS AND METHODS The authors performed a survey of US dermatologists attending a national conference. The proportion aware of the melanoma reporting mandate and the proportion who routinely report newly diagnosed cases were calculated. RESULTS Ninety-one percent (158/174) of those sampled completed the survey. Forty-nine percent correctly identified melanoma as being a disease of mandated reporting. Only 34% reported newly diagnosed cases to their state registry. Dermatologists seeing low melanoma volumes were less likely to routinely report newly diagnosed cases to registries than those seeing high volumes (22.9% vs 45.4%, p = .004). Those in practice for ≤10 years were less likely to be aware of the mandate than those in practice longer (32.6% vs 57.0%, p = .006). CONCLUSION Most dermatologists remain unaware of melanoma reporting requirements. Resultant underestimates of the true incidence of melanoma could have resource allocation implications. Interventions aimed at improving knowledge of the mandate should focus on younger clinicians and those with lower melanoma case volumes.

Dogs are definitive hosts for the lungworms Crenosoma vulpis and Angiostrongylus vasorum. Intermediate hosts are gasteropoda (Mollusca). In the past, lungworms in dogs were rarely identified in the Czech Republic and in neighbouring countries. A total of 253 dogs were sampled for faecal analysis performed by the Baermann method for isolation of first stage larvae (L1) of lungworms. A total of 193 serum samples were collected and analysed by ELISA for the detection of a circulating antigen and specific antibodies against A. vasorum. All dog owners were asked to fill out a questionnaire. Nine dogs (4.7%, 95% Confidence Interval, CI: 2.2–8.7%) were positive for the A. vasorum circulating antigen, seven dogs (3.6%, CI: 1.5–7.3%) had specific antibodies against A. vasorum; of these, three animals (1.6%, CI: 0.3–4.5%) were positive for both ELISAs. Most of them were under the age of three years. Only three of 13 seropositive dogs were not healthy, namely, in one dog vomitus was observed and two dogs were pyretic. Faecal samples of 5 dogs were positive for C. vulpis L1 (2.0%, CI: 0.6–4.6%). Angiostrongylus vasorum L1 were found in the faecal sample of one dog (0.4%, CI: 0.01–2.2%). This study illustrates the wide-spread occurrence of lungworms in the Czech Republic. Disease awareness of lungworms among animal owners and veterinarians should be implemented.

A novel microfluidic based robotic sampling system has been developed for sampling and analysis of liquid solutions in nuclear processes. This system couples the use of a microfluidic sample chip with a robotic system designed to allow remote, automated sampling of process solutions in-cell and facilitates direct coupling of the microfluidic sample chip with analytical instrumentation. This system provides the capability for near real time analysis, reduces analytical waste, and minimizes the potential for personnel exposure associated with traditional sampling methods. A prototype sampling system was designed, built and tested. System testing demonstrated operability of the microfluidic based sample system and identified system modifications to optimize performance.

Purpose Medical errors, in particular medication errors, continue to be a troublesome factor in the delivery of safe and effective patient care. Antineoplastic agents represent a group of medications highly susceptible to medication errors due to their complex regimens and narrow therapeutic indices. As the majority of these medication errors are frequently associated with breakdowns in poorly defined systems, developing technologies and evolving workflows seem to be a logical approach to provide added safeguards against medication errors. Summary This article will review both the pros and cons of today's technologies and their ability to simplify the medication use process, reduce medication errors, improve documentation, improve healthcare costs and increase provider efficiency as relates to the use of antineoplastic therapy throughout the medication use process. Several technologies, mainly computerized provider order entry (CPOE), barcode medication administration (BCMA), smart pumps, electronic medication administration record (eMAR), and telepharmacy, have been well described and proven to reduce medication errors, improve adherence to quality metrics, and/or improve healthcare costs in a broad scope of patients. The utilization of these technologies during antineoplastic therapy is weak at best and lacking for most. Specific to the antineoplastic medication use system, the only technology with data to adequately support a claim of reduced medication errors is CPOE. In addition to the benefits these technologies can provide, it is also important to recognize their potential to induce new types of errors and inefficiencies which can negatively impact patient care. Conclusion The utilization of technology reduces but does not eliminate the potential for error. The evidence base to support technology in preventing medication errors is limited in general but even more deficient in the realm of antineoplastic therapy. Though CPOE has the best evidence to support its use in the antineoplastic population, benefit from many other technologies may have to be inferred based on data from other patient populations. As health systems begin to widely adopt and implement new technologies it is important to critically assess their effectiveness in improving patient safety.

Background Malignant melanoma is considered to be highly resistant to chemotherapy, radiotherapy, hormonotherapy and standard immunotherapy (interleukin 2, interferon alpha). Radical surgery in the early stages of the disease is still the most efficient method. Since the development of immunotherapy and targeted therapy, the role of palliative chemotherapy for advanced disease may be changing. Case A case report regarding 44-year-old woman with extensive tumor of the pectoral wall with contralateral axillary lymphadenopathy is presented. On the basis of imaging methods, histology and immunohistochemistry, the tumor was defined as a sarcoma. Due to PAX7-FKHR fusion gene positivity, rhabdomyosarcoma was the most probable classification. The patient was treated with radical chemotherapy including iphosphamide, vincristine, actinomycin D and doxorubicin with the effect of partial regression of the tumor. This enabled radical surgery of the chest wall tumor. Pathology proved 70% necrosis of the tumor. A contralateral axillary dissection was performed with a finding of two lymph nodes infiltrated with melanoma. The immunohistochemistry markers S100, HMB-45 and Melan A were positive. This resulted in a reclassification of the chest wall tumor to malignant melanoma. The following PET/CT scan was negative. A massive progression of the disease occurred after 5 months. B-RAF mutation leads to a plan of targeted therapy with vemurafenib. Conclusion The case demonstrates the limits of the sensitivity and specificity of immunohistochemical markers of melanoma and the ability of this tumor to imitate various tumors including soft tissue sarcomas. A rare -PAX7-FKHR fusion gene positivity considered specific for rhabdomyosarcoma was found. An extraordinary response to radical chemotherapy with surgical resection led to an improvement of the quality of life and to a prolonged survival comparable with the effect of new targeted treatment for malignant melanoma.

Objective Ongoing health reform in the United States encourages quality-based reimbursement methods such as bundled payments for surgery. The effect of such changes on high-risk procedures is unknown, especially at safety net hospitals. This study quantified the burden of diabetes-related amputation and the potential financial effect of bundled payments at safety net hospitals in Texas. Methods We performed a cross-sectional analysis of diabetic amputation burden and charges using publically available data from Centers for Medicare and Medicaid and the Texas Department of Health from 2008 to 2012. Using hospital referral region (HRR)-level analysis, we categorized the proportion of safety net hospitals within each region as very low (0%-9%), low (10%-20%), average (20%-33%), and high (>33%) and compared amputation rates across regions using nonparametric tests of trend. We then used charge data to create reimbursement rates based on HRR to estimate financial losses. Results We identified 51 adult hospitals as safety nets in Texas. Regions varied in the proportion of safety net hospitals from 0% in Victoria to 65% in Harlingen. Among beneficiaries aged >65, amputation rates correlated to the proportion of safety net hospitals in each region; for example, patients in the lowest quartile of safety net had a yearly rate of 300 amputations per 100,000 beneficiaries, whereas those in the highest quartile had a yearly rate of 472 per 100,000 ( P = .007). Charges for diabetic amputation-related admissions varied almost 200-fold, from $5000 to $1.4 million. Using reimbursement based on HRR to estimate a bundled payment, we noted net losses would be higher at safety net vs nonsafety net hospitals ($180 million vs $163 million), representing a per-hospital loss of $1.6 million at safety nets vs $700,000 at nonsafety nets ( P Conclusions Regions with a high proportion of safety net hospitals perform almost half of the diabetic amputations in Texas. Changes to traditional payment models should account for the disproportionate burden of high-risk procedures performed by these hospitals.

This thesis deals with a design of equipment for measurements of temperature near the gear tooth flank. Temperature measurements are useful for understanding of processes occurring during gear operation. Measurements of temperature are necessary for application of other measuring systems (for example application of strain gauges). Temperature is parameter for application of right oil type too. The article describes choosing of temperature sensors and a method of data transport from the rotating shaft. Software for data transport and calibration is described here. The calibration of sensors is described too. Instruction for use are introduced in the text. The equipment for temperature measurements was tested on the little stand which was especially designed. The goal of this paper is design and testing of equipment for temperature measurements near a gear tooth flank.

The Idaho National Laboratory prepared a preliminary technical and functional requirements (TF average linear heat generation rate of 300 W/cm. The core inlet temperature for liquid lead or Pb/Bi eutectic is 4200 °C. The design includes approximately seventy-five data measurements such as pressure, temperature, and flow rates. The preliminary estimated cost of construction of the facility is $3.7M (in 2006 $). It is also estimated that the facility will require two years to be constructed and ready for operation.

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Pocta S., M. Svoboda: Incidence of Canine Hypersensitivity in the Region of North Eastern Bohemia. Acta Vet. Brno 2007, 76: 451-459. The aim of the study was to determine the incidence of different types of hypersensitivity disorders in dogs in the region of North Eastern Bohemia in the period of 1994 - 2005. In total 150 dogs were included in the study based on suspected hypersensitivity reaction. The incidence of hypersensitivity disorders in the broadly selected group of patients with dermatological problems was 3.5%. The most common diagnosis was atopic dermatitis (94 cases) followed by fl ea allergy dermatitis (80 cases) and food hypersensitivity (18 cases). In terms of breed predilection, the highest number of hypersensitivity cases were Boxers (100%) and French bulldogs (92.3%) which is signifi cantly higher proportion (p < 0.05) compared to Shar-Peis (50%) and signifi cantly even higher proportion (p < 0.01) compared to other breeds. In relation to age and sex, no signifi cant differences were observed in incidence of hypersensitivity disorders. Canine atopic dermatitis and fl ea allergy dermatitis were most commonly diagnosed between 6 months and 3 years of age. Sex predilection was not observed in any of the hypersensitivity reactions. Hormonal hypersensitivity was diagnosed in 4 patients over 6 years of age. Angioedema, rash and insect bite hypersensitivity was diagnosed in 8 acute cases where fast recovery was observed after institution of appropriate therapy.

Kolevska J., V. Brunclik, L. Barto‰ova, M. Svoboda: Trilostane Treatment of Canine Alopecia X in an American Pit Bull Terrier. Acta Vet. Brno 2007, 76: 113-120. This paper describes the case of a one-year-old female American Pit Bull Terrier, presented with the history of progressive baldness. The initial clinical signs were demonstrated by symmetric, primarily non-pruritic alopecia that began in the perineal, genital, and ventral abdominal regions and propagated cranially to the thorax and to the neck. Based on physical and dermatological examination, laboratory findings, and results of skin biopsy, a hormone-responsive dermatosis was diagnosed. Once hypothyroidism and hyperadrenocorticism were ruled out, with the help of hormonal tests, the diagnosis was specified as alopecia X. The first treatment option recommended for the patient and subsequently completed was ovariohysterectomy. After three months, the owner reported improvement; the dog was almost covered with hair. The patient was presented again six months later, showing almost the same dermatological symptoms, which, however, were of a more striking character than before ovariohysterectomy. Again a series of hormonal tests was carried out. Considering the elevated basal and post-adrenocorticothropin stimulation progesterone concentrations, the final aetiology of the disease was determined as an adrenal sex hormone imbalance. Therefore trilostan therapy was initiated. The trilostan dosage of 8 mg/kg/day was divided and given 2 times daily. This treatment led to complete hair regrowth in the dog within four months. No adverse effects associated with trilostane were recognized. Congenital adrenal hyperplasia-like syndrome, progesterone, adrenal sex hormone imbalance

Pocta S., M. Svoboda: Approach to the Diagnostics of Atopic Dermatitis in Dogs in Conditions of Clinical Practice. Acta Vet. Brno 2007, 76: 461-468. The aim of this work was to elucidate the incidence of atopic dermatitis in dogs regarding their age, sex and individual breeds, verify the diagnostic criteria of the disease by Willemse and Prelaund and evaluate their sensitivity in the conditions of this country. In the group of 94 dogs, atopic dermatitis was diagnosed in the period from 1994 to 2005. The highest frequency among breeds was documented in Boxer (100%) and French Bulldog (84.6%), being signifi cantly (p < 0.05) higher than in Shar-pei (41.7%) and Dalmatian (41.7%). The difference was even highly signifi cant (p < 0.01) compared to Dachshund (2.7%), German Shepherd (6%), Cocker Spaniel (11.1%), and Poodle (3.3%). On the other hand, no signifi cant differences were found between sexes. The commonly affected age group was 67 patients (71.2% cases) at the age between three and six years. The diagnosis was made using the clinical criteria by Willemse and Prelaund to verify the sensitivity of these criteria. It was found to be 72% by Willemse, 68% by Prelaund, and the difference was not statistically signifi cant. In all 94 patients various stages of pruritus were detected. The most frequent clinical signs were facial or digital affecting 94.7% patients (89/91) and secondary pyoderma was found in 72.3% patients (68/94). Skin allergy test for specifi cation of the diagnosis was performed in 73.4% cases (69/94). Hypersensitivity, atopy, allergen, clinical criteria, pruritus

This study explores the biological validation of markers of acute stress in pigs subjected to transportation for slaughter. The stress markers selected for monitoring were neopterin and cortisol. Their levels in pig serum were measured for two porcine stress syndrome genotypes, NN and Nn, after a 30-min transport to a slaughterhouse. Blood samples were withdrawn before transport (control group) and immediately after the animals' arrival (experimental group). The values of neopterin and cortisol measured before the transport were 5.60+/-1.65 nmol/l and 273.54+/-66.17 nmol/l respectively. After the transfer, the concentration of cortisol rose significantly compared to the control (355.69+/-85.13 nmol/l, p