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Metastasis to the skin from cervical carcinoma is relatively uncommon. Herein we present a 41-year-old woman with a history of cervical carcinoma with severe facial erythematous swelling and telangiectasia. She was initially treated for cellulitis without improvement. A skin biopsy specimen revealed widespread intravascular tumor emboli in the dermis and subcutis, resembling the so-called inflammatory carcinoma of the breast. As this is an unusual clinical presentation for the metastasis of cervical carcinoma, this case is reported.

Background Advance directives (AD) and advance care planning (ACP) are critical to making patient-centered end-of-life decisions. Despite their importance, completion rates for AD in the United States remain low at about 18–36%. Lack of education related to AD and not understanding AD have been cited as key reasons for not participating in ACP or completing AD. Purpose The purpose of this quasi-experimental pilot study was to assess the effectiveness of a nurse led educational AD seminar that used the Five Wishes on attitudes related to AD, AD completion, and participation in ACP conversations. Methods A post-test repeated measures design was used. Results Of the 86 participants who attended the seminar, most ( n =71, 82.6%) found the seminar useful, and 97.7% ( n =84) reported that they were likely to complete an AD and participate in ACP conversations with family or friends. Overall attitudes about ADs were high. Older females were more likely to complete AD than their younger male counterparts, and women were more likely than men to have ACP conversations. Conclusion The results of this study lend support to the role of nursing-driven community-based educational interventions to improve AD completion and participation in the ACP process.

Melasma is an acquired pigment disorder showing symmetrical hyperpigmentation of the face characterized by light to dark brown patches with indistinct borders on both cheeks. Melasma is prevalent in middle-aged women with harmless hormone imbalances. It is also known as the mask of pregnancy and is prevalent in most child-bearing women. It fluctuates month by month, and yet, there is no promising treatment. The Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd:YAG) laser (1,064-nm wavelength) was introduced in Asia years ago for both skin toning and treatment of facial pigment. This low-fluence, 1,064-nm QS-Nd: YAG laser also reportedly improved melasma. Adjunctive treatments such as vitamin C iontophoresis or chemical peels were recommended in other reports. The technique using the 1,064-nm QS-Nd:YAG laser for toning and the enhancement of adjunctive treatments need further investigation and long-term follow-up before recommendations for the ideal protocol for melasma treatment can be made. The aim of this study is to evaluate the improvement of melasma using different parameters with the 1,064-nm QS-Nd:YAG laser with ultrasonic application of topical vitamin C. Eight patients, ranging in age from 32 to 45 years (mean 37 years), with long-term melasma were studied. Most of the melasma cases were dermal or mixed-type melasma. The patients had no cosmetic treatment (laser, intense pulsed light, or chemical peel) 1 year prior to the study. The entire face of each patient was treated with the 1,064-nm QS-Nd:YAG laser for four sessions at 1-month intervals. The laser treatment was divided into three parts with different parameters. First, each patient underwent whole face exposure for one pass with an 8-mm spot size at a power of 2.0 J/cm(2). Next, the spot size was shifted to 6 mm at a power of 3.5 J/cm(2) for one full-face pass, and then ended with a 4-mm spot size at 3.2 J/cm(2) for one full-face pass, with multiple passes for the main lesions. The end point was mild erythema and swelling, without petechiae. All patients applied ice packs for 5 min before the adjunctive treatment. We designed a split-face study with or without ultrasonic application of topical vitamin C. Only the right side of the face received ultrasonic melasma application of vitamin C for 15 min after ice packing. The left side of the face was covered with a moisturizing lotion. Objective evaluation was performed with visual analog score. All eight patients completed the 3-month follow-up after the four laser treatments. Statistics showed significant improvement with ultrasonic application of vitamin C compared to laser monotherapy. The improvement was more pronounced during second to fourth sessions. There was no rebound or post-inflammatory hyperpigmentation detected during the 3-month follow-up period. The combination of 1,064-nm QS-Nd:YAG laser treatment with ultrasonic application of topical vitamin C exerted more prompt response of melasma. We recommended this protocol including mixed parameters of 1,064-nm QS-Nd:YAG laser toning method combining with vitamin C ultrasonic application that can yield higher satisfaction for the difficult facial pigmentation problems such as melasma.

This investigation reports a 68-year-old man with a history of hepatocellular carcinoma (HCC) diagnosed 2 years previously who developed a single, easy-bleeding, pyogenic granuloma (PG)-like lesion on his right upper abdomen, located in the area of previous therapeutic percutaneous ethanol injection (PEI) for HCC treatment. The lesion developed 3 months after the injection. The tumor was found to be identical to his previous HCC.To describe a case of cutaneous seeding of HCC during PEI presented as a PG-like lesion. To our knowledge, this is the first such case reported in the literature.This is a case report and review the literature.Immunostainings for alpha-fetoprotein and hepatocyte monoclonal antibody confirmed the diagnosis. Besides, the patient had no other metastatic lesion.This tumor is believed to be caused by cutaneous seeding of HCC during PEI and is simulated clinically as a PG.

Previous studies have shown that single or multiple treatments by focused ultrasound are effective and safe. However, most include focused ultrasound only and not radio-frequency treatment. There is paucity of magnetic resonance imaging (MRI) measurements and pictures in the literature. This study aimed to assess the efficacy, safety, and pain and satisfaction levels of the combination therapy of focused ultrasound and radio-frequency for improving body contours. Thirty-two Asian patients received 3 sequential treatments every 2 weeks in the abdominal region. Safety parameters and adverse events were recorded. The subjects' pain and satisfaction levels were evaluated using a five-point Likert scale. Two patients underwent MRI study randomly. There was a mean reduction in circumference of 3.91 ± 1.8 cm (p ≤ 0.001). In MRI measurement, the average in fat thickness reduction was 21.4 and 25% on the upper and lower abdomen, respectively. There were three mild and self-limited localized adverse events. The satisfaction survey showed that 71.9% was satisfied with the results, while pain level evaluation showed that 90.5% felt no pain. Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring is an effective, safe, and painless procedure in Asians. Although the change is minor compared to traditional surgical procedure, it is real, definite, and effective.

Nurses are increasingly engaged in evidence-based practice (EBP) processes to answer significant questions and guide nursing practice. However, there are no criteria to evaluate the rigor and quality of EBP projects, making the decision about whether to implement a recommended practice change questionable.The purpose of this study was to achieve consensus among nationally recognized EBP nurse experts on criteria that could be used to appraise the methodological quality of an EBP project as well as to serve as a guideline to plan for an EBP project.A modified two-round Delphi method was used. Twenty-three nationally known EBP experts were invited by e-mail to participate in completing a web-based questionnaire.Items converged after two rounds (response rate [52% (n=12/23) for Round 1 and 35% (n=8/23) for Round 2]) and resulted in the development of the EBP Process Quality Assessment (EPQA) guidelines that include 34 items.The EPQA guidelines can be used to guide and evaluate the methodological quality of EBP projects. They can be used in practice settings to critically appraise an EBP project prior to translating recommendations into practice. Educators can use the EPQA guidelines as a rubric to evaluate student EBP projects. EPQA guidelines can be utilized in research to assess interventions and to build or improve EBP capacity.

BACKGROUND In recent years, using the 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser (QSNYL) with or without exogenous topical carbon solution application for facial skin rejuvenation has become popular in Southeast Asia, but there has not been any published clinical report discussing the rejuvenation effect of QSNYL for Asian patients. OBJECTIVE To evaluate the efficacy of QSNYL in improvement of pore size, sebaceous secretion, skin texture, and skin tone of Asian patients. We also observed whether there is any enhancement of application of topical carbon solution before the therapy. METHODS Twenty-four female patients completed four sessions of treatments at 4-week intervals. The assessment was evaluated by the patients, two independent physicians, and Canfield VISIA Complexion Analysis. In addition, we conducted a split-face study such that, in each case, topical carbon solution was applied to the right side of the face before the laser treatment. RESULTS All evaluations showed significant improvement in rejuvenation effect. There was no difference in improvement in skin texture even after the application of topical carbon solution in our split-face study. CONCLUSION The QSNYL is a safe and effective rejuvenation modality in Asian patients. Topical carbon solution application did not enhance laser efficacy.

Atrophic facial acne scars is one of the most common problems in patients with inflammatory acne. Ablative laser resurfacing has unpleasant complications and a long recovery period. Nonablative therapies yield less improvement and satisfaction. The introduction of fractional photothermolysis (FP) is an alternative treatment for atrophic acne scars.To evaluate the effectiveness and safety of a nonablative 1,550-nm erbium-doped fiber laser in the FP of atrophic facial acne scars in one treatment session.Forty-five patients (skin type III-IV, mean age 29) with atrophic facial acne scars were enrolled in the study. Each patient received one treatment of FP. Comparative photographs were taken using specific complexion analysis to identify and quantify depressed scars and texture. Physician evaluations and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit.The improvement in atrophic scars and texture after a FP treatment were significant. Twenty-seven (60%) of the patients had good to excellent results after 1 month.The FP of atrophic facial acne scars resulted in significant improvement even in a single treatment, with good satisfaction and unremarkable side effects.

Involvement of the central nervous system (CNS) by tuberculosis is rare; it can affect either immunocompromised or immunocompetent people.Here, we report a case of tuberculosis with CNS involvement. We present the case of an immunocompetent young man who developed fever, subacute headache, disturbance of consciousness, paraparesis, sphincter dysfunction, and hypoesthesia. The final diagnosis was tuberculous meningitis, myeloradiculitis and arachnoiditis based on clinical signs, imaging studies, and cerebrospinal fluid culture. The patient received antituberculosis medication with adjunct intravenous steroid therapy. Although his clinical condition improved significantly, some neurological sequelae persisted.Methods for detection of CNS TB and treatment protocols should be constantly re-evaluated to improve treatment outcome and reduce likelihood and severity of neurological sequelae.

Common genetic variants that increase the risk for Parkinson's disease may differentiate patient subgroups and influence future individualized therapeutic strategies. Herein we show evidence for leucine-rich repeat kinase 2 (LRRK2) c.4883G>C (R1628P) as a risk factor in ethnic Chinese populations. A study of 1,986 individuals from 3 independent centers in Taiwan and Singapore demonstrates that Lrrk2 R1628P increases risk for Parkinson's disease (odds ratio, 1.84; 95% confidence interval, 1.20-2.83; p = 0.006). Haplotype analysis suggests an ancestral founder for carriers approximately 2,500 years ago. These findings support the importance of LRRK2 variants in sporadic Parkinson's disease. Ann Neurol 2008.

In this study, 2-acrylamidophenylboronate (2-APB) was synthesised and its ability to bind with glucose was investigated both in solution and when integrated into a holographic sensor. Multiple forms of 2-APB, resulting from the neighbouring effect of the amido group with the boronic acid through an intramolecular B--O-coordinated interaction, were shown to exist in solution by using multinuclear NMR spectrometry. It was found that 2-APB predominantly adopts a zwitterionic tetrahedral form at physiological pH values. The complex formation of 2-APB with glucose and lactate was investigated in DMSO; 2-APB favours binding with glucose rather than lactate and generates a five-membered-ring complex. Furthermore, a 2-APB-based holographic sensor displayed a significant response to glucose with little interference from lactate, and with no dependence on pH in the physiological pH range. These features suggest that the new ligand 2-APB is a potential candidate for the development of glucose-selective sensors.