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Although many plants have been investigated for their antifungal activity against candidiasis, more treatment options remain needed. This study evaluated the antifungal activity of 19 essential oils against Candida albicans. Nineteen essential oils, at concentrations of 1% and 0.5%, were added to cultures of C. albicans and incubated at 37°C for 18 h. The optical density was measured at 600 nm. The antifungal activity of the essential oils against C. albicans was dependent on concentration and the extraction site. At 0.5%, essential oils from thyme, palmarosa, and lemongrass displayed higher antifungal activities than fluconazole, suggesting that they are effective against C. albicans. The essential oils of eucalyptus, rosewood, and lavender showed the highest activity at 1% concentration and may be used as antibiotics individually. In addition, the essential oils extracted from leaves, such as thyme, were found to have higher antifungal activity than those from other sites.

The emergence of multidrug-resistant microorganisms represents a global challenge owing to the lack of new effective antimicrobial agents. Essential oils could be an alternative to antibiotics because of their anti-inflammatory, antiviral, antibacterial, and antibiofilm activities. Therefore, this study aimed to investigate the antibacterial activity of essential oils as an alternative to antibiotics. In the present study, we cultured methicillin-resistant Staphylococcus aureus (MRSA) with two concentrations (0.5% and 1.0%) of 17 types of essential oils and the antibiotic oxacillin as the control. The optical density of the culture suspensions at 600 nm was determined to assess the effect of the essential oils on MRSA. At 0.5% concentration, 8 essential oils demonstrated higher antibacterial activity than oxacillin, with palmarosa, melissa true, and rose geranium showing the highest antibacterial activity. At 1% concentration, 13 essential oils showed higher antibacterial activity than oxacillin, with melissa true, palmarosa, lemongrass, and rosemary verbenone showing the highest antibacterial activity. Furthermore, essential oils isolated from leaves showed higher antibacterial ability. Overall, the antibacterial activity of essential oils against MRSA varied with the concentration, type, and extraction site. Therefore, our study provides a basis for the selection and use of essential oils for antibacterial activity against MRSA.

Figure S4 shows that radiotherapy and immunotherapy can synergistically induce tumoral ferroptosis

A challenge in oncology is to rationally and effectively integrate immunotherapy with traditional modalities, including radiotherapy. Here, we demonstrate that radiotherapy induces tumor-cell ferroptosis. Ferroptosis agonists augment and ferroptosis antagonists limit radiotherapy efficacy in tumor models. Immunotherapy sensitizes tumors to radiotherapy by promoting tumor-cell ferroptosis. Mechanistically, IFNγ derived from immunotherapy-activated CD8+ T cells and radiotherapy-activated ATM independently, yet synergistically, suppresses SLC7A11, a unit of the glutamate–cystine antiporter xc−, resulting in reduced cystine uptake, enhanced tumor lipid oxidation and ferroptosis, and improved tumor control. Thus, ferroptosis is an unappreciated mechanism and focus for the development of effective combinatorial cancer therapy.Significance:This article describes ferroptosis as a previously unappreciated mechanism of action for radiotherapy. Further, it shows that ferroptosis is a novel point of synergy between immunotherapy and radiotherapy. Finally, it nominates SLC7A11, a critical regulator of ferroptosis, as a mechanistic determinant of synergy between radiotherapy and immunotherapy.This article is highlighted in the In This Issue feature, p. 1631

Table S1 shows the information on the antagonists and agonists used in this study

Supplementary Materials

Supplementary Figures S1-S4

Purpose:Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that can be divided into two classes: virus-positive (VP) MCC, associated with oncogenic Merkel cell polyomavirus (MCPyV); and virus-negative (VN) MCC, associated with photodamage.Experimental Design:We classified 346 MCC tumors from 300 patients for MCPyV using a combination of IHC, ISH, and qPCR assays. In a subset of tumors, we profiled mutation status and expression of cancer-relevant genes. MCPyV and molecular profiling results were correlated with disease-specific outcomes. Potential prognostic biomarkers were further validated by IHC.Results:A total of 177 tumors were classified as VP-MCC, 151 tumors were VN-MCC, and 17 tumors were indeterminate. MCPyV positivity in primary tumors was associated with longer disease-specific and recurrence-free survival in univariate analysis, and in multivariate analysis incorporating age, sex, immune status, and stage at presentation. Prioritized oncogene or tumor suppressor mutations were frequent in VN-MCC but rare in VP-MCC. TP53 mutation developed with recurrence in one VP-MCC case. Importantly, for the first time we find that VP-MCC and VN-MCC display distinct sets of prognostic molecular biomarkers. For VP-MCC, shorter survival was associated with decreased expression of immune markers including granzyme and IDO1. For VN-MCC, shorter survival correlated with high expression of several genes including UBE2C.Conclusions:MCPyV status is an independent prognostic factor for MCC. Features of the tumor genome, transcriptome, and microenvironment may modify prognosis in a manner specific to viral status. MCPyV status has clinicopathologic significance and allows for identification of additional prognostic subgroups.

Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that is classified as Merkel cell polyomavirus (MCPyV)-positive or virus-negative. Epigenetic changes, such as DNA methylation, can alter gene expression and influence cancer progression. However, patterns of DNA methylation and the therapeutic efficacy of hypomethylating agents have not been fully explored in MCC. We characterized genome-wide DNA methylation in 16 MCC cell lines from both molecular subclasses in comparison to other cancer types, and found that the overall profile of MCC is similar to small cell lung carcinoma. Comparison of virus-positive and -negative MCC revealed 2,260 differentially methylated positions. The hypomethylating agent decitabine (DAC) upregulated expression of antigen-presenting machinery in MCC cell lines and stimulated membrane expression of HLA-A in virus-positive and virus-negative MCC xenograft tumors. DAC also induced prominent caspase- and large T antigen-independent cell death in virus-positive MCC, whereas virus-negative MCC cell lines displayed decreased proliferation without increased cell death. In mouse xenografts, decitabine significantly decreased the size of virus-positive tumors, but not virus-negative tumors. Our findings indicate that viral status predicts genomic methylation patterns in MCC, and that DAC may be therapeutically effective against MCC via anti-proliferative effects, cell death, and increased immune recognition.

The prevalence of candidiasis, a contagious disease with high morbidity and mortality, has sharply increased globally over the last two decades. Candida albicans can cause serious infections in patients with weak immunity and in recipients of prolonged antibiotic treatment. Consequently, rapid and accurate identification of species can play an important role in the treatment of candidiasis. Here, we investigated the positive rate and infection trend of Candida albicans according to age, specimen type, and sex using multiplex real-time polymerase chain reactionbased testing of samples collected for the diagnosis of sexually transmitted diseases in Korea between 2018 and 2020. When the type of specimen collected was a swab, the positive rate of Candida albicans was higher among younger women, and tended to decrease with age. Analysis of swab samples revealed higher positive rates than urinalysis. The reduction trend in positive rates by age was comparable between the overall samples and urine specimens. Among male patients, the positive rate did not differ substantially across the various types of specimens collected. Previous studies have shown a higher prevalence of non-albicans Candida species than Candida albicans in clinical specimens, and exclusion of the former from our analysis may be a limitation of this study. However, our findings contribute significantly to the literature because globally, there is a paucity of epidemiological studies using molecular techniques to detect Candida albicans in sexually transmitted disease test samples.

Purpose Quinoa is an annual plant that grows well in high altitude regions with high radiation and ultraviolet intensity. It has known that high-dose radiation damages living organisms, but low-dose radiation also has a beneficial effect. Therefore, the purpose of this study is to investigate the hormesis effect of gamma-ray on quinoa by growth analysis and hyperspectral imaging. Materials and methods Quinoa seeds were irradiated at 50, 100, and 200 Gy emitted by 60CO. Subsequently, the seeds were germinated and transplanted into pots, then conducted growth analysis and physiological evaluation every week, and hyperspectral imaging. Photosynthetic ability was measured at 35 days after transplanting (DAT), and the plants for each dose were divided into aerial and underground parts for biomass evaluation at 91 DAT. Various vegetation indices were estimated from 14 to 35 DAT by hyperspectral analysis, and the specific bands were extracted based on the PLS model using plant height, SPAD value, and chlorophyll fluorescence parameters.Results and conclusion: We found that plant height and biomass were increased in quinoa plants treated with a low dose (50 Gy) as compared to control. Chlorophyll content and chlorophyll fluorescence were not different between doses at the early growth stage, but as growth progressed, the plant irradiated at 200 Gy began to be lower. The photosynthetic ability of the quinoa plant treated at 50 Gy was greater than other plants at 35 DAT. The vegetation indices related to the pigment status also were higher in the plants treated by irradiation at 50 Gy than the plants grown in other doses treatment units at the beginning of the growth. Using the PLS model we collected sensitive band wavelengths from hyperspectral image analysis. Among the collected bands, eight bands closely related to plant height, nine bands to chlorophyll content, and ten bands to chlorophyll fluorescence were identified. Conclusion Our results showed that the growth and physiological parameters of quinoa treated by low dose gamma irradiation to seeds were greater than that of control as well as the plant with higher doses. These findings confirm that the positive changes in the characteristics of quinoa with low dose radiation indicated that hormesis occurs at 50 Gy radiation.

Augmented reality (AR) is the integration of computer-generated information with the user's environment in real time. AR is used in many industries, including healthcare, where it has gained significant popularity. Recent strides in hardware and software engineering have reduced the cost of AR, while significantly improving the experience for users and developers. One of the first applications of AR technology in perioperative medicine has been in the identification of anatomical structures for regional blocks and peripheral or central vascular access. AR has also been implemented in pediatric care to reduce periprocedural anxiety. In this narrative review, we summarize the current role of AR in anesthesiology, pain medicine, and critical care.

Purpose: Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that can be divided into two classes: virus-positive (VP) MCC, associated with oncogenic Merkel cell polyomavirus (MCPyV); and virus-negative (VN) MCC, associated with photodamage. Experimental Design: We classified 346 MCC tumors from 300 patients for MCPyV using a combination of IHC, ISH, and qPCR assays. In a subset of tumors, we profiled mutation status and expression of cancer-relevant genes. MCPyV and molecular profiling results were correlated with disease-specific outcomes. Potential prognostic biomarkers were further validated by IHC. Results: A total of 177 tumors were classified as VP-MCC, 151 tumors were VN-MCC, and 17 tumors were indeterminate. MCPyV positivity in primary tumors was associated with longer disease-specific and recurrence-free survival in univariate analysis, and in multivariate analysis incorporating age, sex, immune status, and stage at presentation. Prioritized oncogene or tumor suppressor mutations were frequent in VN-MCC but rare in VP-MCC. TP53 mutation developed with recurrence in one VP-MCC case. Importantly, for the first time we find that VP-MCC and VN-MCC display distinct sets of prognostic molecular biomarkers. For VP-MCC, shorter survival was associated with decreased expression of immune markers including granzyme and IDO1. For VN-MCC, shorter survival correlated with high expression of several genes including UBE2C. Conclusions: MCPyV status is an independent prognostic factor for MCC. Features of the tumor genome, transcriptome, and microenvironment may modify prognosis in a manner specific to viral status. MCPyV status has clinicopathologic significance and allows for identification of additional prognostic subgroups.

Metastasis is the primary cause of cancer mortality, and cancer frequently metastasizes to the liver. It is not clear whether liver immune tolerance mechanisms contribute to cancer outcomes. We report that liver metastases diminish immunotherapy efficacy systemically in patients and preclinical models. Patients with liver metastases derive limited benefit from immunotherapy independent of other established biomarkers of response. In multiple mouse models, we show that liver metastases siphon activated CD8+ T cells from systemic circulation. Within the liver, activated antigen-specific Fas+CD8+ T cells undergo apoptosis following their interaction with FasL+CD11b+F4/80+ monocyte-derived macrophages. Consequently, liver metastases create a systemic immune desert in preclinical models. Similarly, patients with liver metastases have reduced peripheral T cell numbers and diminished tumoral T cell diversity and function. In preclinical models, liver-directed radiotherapy eliminates immunosuppressive hepatic macrophages, increases hepatic T cell survival and reduces hepatic siphoning of T cells. Thus, liver metastases co-opt host peripheral tolerance mechanisms to cause acquired immunotherapy resistance through CD8+ T cell deletion, and the combination of liver-directed radiotherapy and immunotherapy could promote systemic antitumor immunity. Liver metastases reduce clinical and preclinical immune-checkpoint inhibitor efficacy through hepatic siphoning of circulating activated CD8+ T cells, but therapeutic benefit can be improved by combining immunotherapy with liver-directed radiotherapy.

A total of 59,381 specimens isolated at a clinical laboratory from September 2018 to December 2020 were subjected to real-time PCR for the detection ofAmong 59,381 samples, 20,718 (34.8%) were positive forFrom 2018 to 2020 in Korea, the number of tests conducted for bacterial vaginosis has increased, while the incidence of

Cognitive impairment is observed in 12% to 56% of stroke patients, and screening for cognitive impairment is often complex and time-consuming, with results dependent on patient compliance. Therefore, there is a need for an objective method to assess cognitive impairment regardless of patient compliance. Objective evaluation methods include electroencephalogram (EEG) and event-related potential (ERP). This study was conducted to assess intra-tester reliability of resting EEG-based spectral features and auditory/visual P300 latency/amplitude in patients with subacute ischemic stroke. Twenty patients with subacute ischemic stroke were included in the study. The resting EEG and P300 wave using an auditory and visual oddball paradigm were measured at baseline and once again in 24 hours. The following electrode positions (10-20 system) were constantly recorded: F3 (Frontal), Fz, F4, C3 (Central), Cz, C4, P3 (Parietal), Pz, P4. DAR (delta/alpha ratio) and BSI (brain symmetry index) were determined using EEG data. F3 and F4, C3 and C4 and P3 and P4 were switched according to the stroke side and classified as affected hemisphere (AH) and unaffected hemisphere (UH) after the evaluation. In ERP, the amplitude and latency of P300 were obtained. In reliability analysis of EEG-based spectral characteristics, significant reliability was observed for DAR (ICC = 0.447), BSldir (ICC = 0.713) and BSIdirtheta (ICC = 0.724) (Table 4). DAR was showed a poor ICC level, and BSIdir and BSIdirtheta had a moderate ICC level. Visual P300 latency showed excellent intraclass correlation coefficient (ICC) in several montages (PUH = 0.972, Pz = 0.945). In 6 montages, auditory P300 latency was reliable, while in 9 montages, visual P300 latency was reliable. In 4 montages, auditory P300 amplitude was reliable, while visual P300 amplitude was reliable in 7. The visual P300 was more reliable than the auditory P300. The ICC values for P300 latency were greater than those for amplitude. Therefore, when ERP is performed on subacute stroke patients, visual has higher reliability than auditory.

Multi-tyrosine kinase inhibitors (MTKIs) have thus far had limited success in the treatment of castration-resistant prostate cancer (CRPC). Here, we report a phase I-cleared orally bioavailable MTKI, ESK981, with a novel autophagy inhibitory property that decreased tumor growth in diverse preclinical models of CRPC. The anti-tumor activity of ESK981 was maximized in immunocompetent tumor environments where it upregulated CXCL10 expression through the interferon gamma pathway and promoted functional T cell infiltration, which resulted in enhanced therapeutic response to immune checkpoint blockade. Mechanistically, we identify the lipid kinase PIKfyve as the direct target of ESK981. PIKfyve-knockdown recapitulated ESK981's anti-tumor activity and enhanced the therapeutic benefit of immune checkpoint blockade. Our study reveals that targeting PIKfyve via ESK981 turns tumors from cold into hot through inhibition of autophagy, which may prime the tumor immune microenvironment in advanced prostate cancer patients and be an effective treatment strategy alone or in combination with immunotherapies.

Cancer immunotherapy restores or enhances the effector function of CD8+ T cells in the tumour microenvironment1,2. CD8+ T cells activated by cancer immunotherapy clear tumours mainly by inducing cell death through perforin-granzyme and Fas-Fas ligand pathways3,4. Ferroptosis is a form of cell death that differs from apoptosis and results from iron-dependent accumulation of lipid peroxide5,6. Although it has been investigated in vitro7,8, there is emerging evidence that ferroptosis might be implicated in a variety of pathological scenarios9,10. It is unclear whether, and how, ferroptosis is involved in T cell immunity and cancer immunotherapy. Here we show that immunotherapy-activated CD8+ T cells enhance ferroptosis-specific lipid peroxidation in tumour cells, and that increased ferroptosis contributes to the anti-tumour efficacy of immunotherapy. Mechanistically, interferon gamma (IFNγ) released from CD8+ T cells downregulates the expression of SLC3A2 and SLC7A11, two subunits of the glutamate-cystine antiporter system xc-, impairs the uptake of cystine by tumour cells, and as a consequence, promotes tumour cell lipid peroxidation and ferroptosis. In mouse models, depletion of cystine or cysteine by cyst(e)inase (an engineered enzyme that degrades both cystine and cysteine) in combination with checkpoint blockade synergistically enhanced T cell-mediated anti-tumour immunity and induced ferroptosis in tumour cells. Expression of system xc- was negatively associated, in cancer patients, with CD8+ T cell signature, IFNγ expression, and patient outcome. Analyses of human transcriptomes before and during nivolumab therapy revealed that clinical benefits correlate with reduced expression of SLC3A2 and increased IFNγ and CD8. Thus, T cell-promoted tumour ferroptosis is an anti-tumour mechanism, and targeting this pathway in combination with checkpoint blockade is a potential therapeutic approach.

Neuroblastoma (NB) is the most common extracranial pediatric tumor, and accounts for approximately 12% of cancer-related deaths in children. Though several genomic drivers have been identified, the development of targeted therapy for treating this aggressive pediatric malignancy has yet to be realized. Thus, there exists an urgent need to develop alternative therapeutic strategies for treating aggressive and metastatic NB. One novel approach is to therapeutically target anaplastic lymphoma kinase (ALK) and focal adhesion kinase (FAK), which are multi-functional tyrosine kinases implicated in neural development and play an important role in growth and metastasis of several cancers. Genomic aberrations of ALK such as overexpression, amplifications, and mutations, have been reported in NB. The role of FAK has also been delineated in NB as well as associated with disease metastasis. Using in silico analysis of sequencing data from NB patients procured from Pediatric MI-ONCOSEQ (precision oncology program), we found a cohort of patients that express high ALK and FAK expression. Given the potential roles of ALK and FAK in NB, we evaluated the efficacy of a novel compound ESK440, which is a dual ALK and FAK inhibitor. ESK440 has passed Phase 1 clinical trials in adult patients with solid tumors. It is capable of crossing the blood brain barrier and binds to several mutated forms of ALK, thus making ESK440 an attractive therapeutic candidate for treating NB. A wide panel of NB cancer cell lines were screened with ESK440, and a CellTiter-Glo® Luminescent Cell Viability Assay was used to determine the IC-50s. Our results revealed that NB cells with ALK genomic aberrations (mutations and amplifications) showed low IC-50 values. Further, treatment with ESK440 inhibited ALK and FAK associated signaling pathways. We also observed decreased expression of MYCN. Intriguingly, ESK440 studies in NB xenograft model (NB-1) resulted in tumor regression in treated animals. Altogether, our study has discovered the therapeutic potential of dual ALK and FAK inhibitor in NB, and our findings may provide the foundation for initiating clinical trials targeting this disease in pediatric patients. Citation Format: Seema Chugh, Jean C. Tien, Jennifer Hon, Pushpinder Singh Bawa, Carson Kenum, Chi Chiang Li, Yunhui Cheng, Andrew D. Delekta, Jae Eun Choi, Rahul Mannan, Yuanyuan Qiao, Rajen Mody, Arul Chinnaiyan. Therapeutic benefit of dual ALK and FAK inhibition in neuroblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2018.

Quinoa is an annual plant that grows well in high altitude regions with high radiation and ultraviolet intensity. It has known that high-dose radiation damages living organisms, but low-dose radiation also has a beneficial effect. Therefore, the purpose of this study is to investigate the hormesis effect of gamma-ray on quinoa by growth analysis and hyperspectral imaging.Quinoa seeds were irradiated at 50, 100, and 200 Gy emitted byWe found that plant height and biomass were increased in quinoa plants treated with a low dose (50 Gy) as compared to control. Chlorophyll content and chlorophyll fluorescence were not different between doses at the early growth stage, but as growth progressed, the plant irradiated at 200 Gy began to be lower. The photosynthetic ability of the quinoa plant treated at 50 Gy was greater than other plants at 35 DAT. The vegetation indices related to the pigment status also were higher in the plants treated by irradiation at 50 Gy than the plants grown in other doses treatment units at the beginning of the growth. Using the PLS model we collected sensitive band wavelengths from hyperspectral image analysis. Among the collected bands, eight bands closely related to plant height, nine bands to chlorophyll content, and ten bands to chlorophyll fluorescence were identified.Our results showed that the growth and physiological parameters of quinoa treated by low dose gamma irradiation to seeds were greater than that of control as well as the plant with higher doses. These findings confirm that the positive changes in the characteristics of quinoa with low dose radiation indicated that hormesis occurs at 50 Gy radiation.

Augmented reality (AR) is the integration of computer-generated information with the user's environment in real time. AR is used in many industries, including healthcare, where it has gained significant popularity. Recent strides in hardware and software engineering have reduced the cost of AR, while significantly improving the experience for users and developers. One of the first applications of AR technology in perioperative medicine has been in the identification of anatomical structures for regional blocks and peripheral or central vascular access. AR has also been implemented in pediatric care to reduce periprocedural anxiety. In this narrative review, we summarize the current role of AR in anesthesiology, pain medicine, and critical care.

Strategies that interfere with the binding of the receptor programmed cell death protein-1 (PD-1) to programmed death ligand-1 (PD-L1) have shown marked efficacy against many advanced cancers, including those that are negative for PD-L1. Precisely why patients with PD-L1 negative tumors respond to PD-1/PD-L1 checkpoint inhibition remains unclear. Here, we show that platelet-derived PD-L1 regulates the growth of PD-L1 negative tumors and that interference with platelet binding to PD-L1 negative cancer cells promotes T cell-induced cancer cytotoxicity. These results suggest that the successful outcomes of PD-L1 based therapies in patients with PD-L1 negative tumors may be explained, in part, by the presence of intra-tumoral platelets. Altogether, our findings demonstrate the impact of non-cancer/non-immune cell sources of PD-L1 in the tumor microenvironment in the promotion of cancer cell immune evasion. Our study also provides a compelling rationale for future testing of PD-L1 checkpoint inhibitor therapies in combination with antiplatelet agents, in patients with PD-L1 negative tumors.

Summary Immunotherapy induces durable clinical responses in a fraction of patients with cancer. However, therapeutic resistance poses a major challenge to current immunotherapies. Here, we identify that expression of tumor stanniocalcin 1 (STC1) correlates with immunotherapy efficacy and is negatively associated with patient survival across diverse cancer types. Gain- and loss-of-function experiments demonstrate that tumor STC1 supports tumor progression and enables tumor resistance to checkpoint blockade in murine tumor models. Mechanistically, tumor STC1 interacts with calreticulin (CRT), an "eat-me" signal, and minimizes CRT membrane exposure, thereby abrogating membrane CRT-directed phagocytosis by antigen-presenting cells (APCs), including macrophages and dendritic cells. Consequently, this impairs APC capacity of antigen presentation and T cell activation. Thus, tumor STC1 inhibits APC phagocytosis and contributes to tumor immune evasion and immunotherapy resistance. We suggest that STC1 is a previously unappreciated phagocytosis checkpoint and targeting STC1 and its interaction with CRT may sensitize to cancer immunotherapy.

Background: Children often have limited understanding of clinical research and what they might expect from participating in a clinical study. Studies, however, suggest that multimedia delivery of medical and research information may promote greater understanding and engagement compared with standard written approaches. Aim: This study was designed to examine the effects of a novel interactive augmented reality (AR) program on children’s understanding of clinical research. Methods: Children (ages 7-13 years) were randomized to receive the basic information about clinical research using either a printed storybook (control) or the same storybook enhanced using a video see-through AR iPad program (AR) with embedded interactive quizzes. Children were interviewed to assess their understanding of the material before (pre-test) and after (post-test) receiving either of the randomized interventions. Both parents and children completed short surveys to measure their perceptions of the information delivery. Results: Ninety-one parent/child dyads were included in the analysis. There were no differences between the control and AR children’s pre-test understanding of the research information. However, both groups demonstrated significant and similar improvements in post-test understanding. Parents of children in the AR group found the information to be of higher quality and greater clarity compared with the control group, and 91.7% of children in the AR group found the inclusion of interactive quizzes to be helpful. Both parents and children found the AR program very easy to use and 85.0 % and 71.2%, respectively, indicated that if recruited for a future study that they would prefer information delivered using some type of iPad AR program together with a discussion with the researcher. Conclusions: Results demonstrated the importance of providing children and parents with information in an easy to read and visually compelling manner. Although both groups demonstrated improved understanding, children and their parents preferred the AR program and reported a preference for receiving information using computer-based technology. Given the seemingly insurmountable challenge of keeping children and families engaged in health research related information exchange, the use of AR would appear to provide a novel and effective vehicle for enhancing children’s and parents assimilation and understanding of research (and medical) information and as a potential tool to optimize the informed consent and assent processes. Relevance for patients: This study reinforces the importance in providing information to research participants and patients in an easy-to-read and visually salient manner. Although the AR program used in this study did not result in an increased level of understanding, AR was deemed the preferred method of information delivery. It is hoped that the results of this study will serve as a platform for future studies.

Background/purpose Skin commensal bacteria have been described to help orchestrate skin homeostasis, signaling through innate immunity pathways. This study for the first time aimed at studying the relationship between skin commensals and melanocytes after UVB exposure. Methods An in vitro UVB radiation model with normal human epidermal melanocytes (NHMs) and skin commensal bacteria supernatant from Staphylococcus epidermidis and Propionibacterium acnes was established. Melanocytes DNA damage, cyclobutane pyrimidine dimers (CPD), and cellular proliferation marker Ki-67 were measured by ELISA and immunofluorescence staining. Cell apoptosis was assessed by flow cytometry and PCR array and RT-qPCR. Results Normal human epidermal melanocytes are able to survive and proliferate while bearing DNA damage after UVB radiation. Skin commensal bacteria S. epidermidis and its by-product LTA promote melanocytes survival by inducing upregulation of TRAF1, CASP14, CASP5, and TP73. On the other hand, P. acnes can inhibit UVB-irradiated melanocytes survival by increasing apoptosis. Conclusion Our studies show different aspects of commensal activity on melanocytes during irradiation. The possible balance achieved by the different skin commensal can influence NHM potential to become cancer cells.

As the Mental Health Welfare Act of 2017 is enacted, in order to grasp the concept of new mental health, the first priority is to understand the awareness of the community members who are the target of the service. The purpose of this study is to examine the changes in the perception of foreign mental illnesses through literature review, and developed a community mental health services project in comparison with Korea. There is a need for an active effort to look at patients discouraging prejudice on psychiatric patients. A place to learn social skills and live together, or a community health center should be used actively. We strongly urge that the construction of infrastructures such as human, material, social and economic support is needed and that a great deal of social attention and support is needed.

Background: Although squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) can be easily diagnosed clinically, proper diagnosis is sometimes difficult when based on clinical information alone. Objective: To know what causes clinical misdiagnosis between SCC and BCC, and evaluate whether dermoscopy can improve diagnostic accuracy. Methods: Clinical and dermoscopic photographs of inversely diagnosed cases (histologically confirmed BCC with a clinical impression of SCC or vice versa) were randomly presented to six dermatologists and the reasons for each correct or incorrect diagnosis were analyzed. Results: Among 154 cases (SCCs or BCCs), 13 cases were inversely diagnosed; 9 SCCs were clinically misdiagnosed as BCC and 4 BCCs were clinically misdiagnosed as SCC. Clinically, scales, pigmentation and rolled border were meaningful factors to discern two carcinomas. Scales without both pigmentation and rolled border was favored for SCC, but BCC favored vice versa. Ulceration, telangiectasia and translucency contributed as confusing factors for proper diagnosis. Dermoscopy improved overall diagnostic accuracy to odds ratio 2.86. Conclusion: SCC has a higher tendency to be clinically misdiagnosed as BCC than vice versa. Pigmentation and rolled border are factors causing misdiagnosis of SCC as BCC and BCC may be misdiagnosed as SCC in the presence of scaling. Dermoscopy seems to improve the clinical diagnostic accuracy but has limitations for some ambiguous lesions. (Ann Dermatol 30(1) 64∼70, 2018)

Erythema induratum of Bazin (EIB) is a form of tuberculid resulting from hypersensitivity to tuberculosis antigen. EIB occurs most commonly in middle-aged women and is not typically seen in children. Here, we present a rare case of EIB, presenting as a chronic nodular panniculitis, in a 10-year-old Korean boy.