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BACKGROUND Survival outcomes in acral lentiginous melanoma (ALM) are worse than for cutaneous melanoma. Diagnostic delays are believed to contribute to worse outcomes in ALM, including advanced-stage disease at initial presentation. Acral lentiginous melanoma, especially in its early stages, may be difficult to discern from benign pigmented acral lesions. OBJECTIVE The purpose of this article is to provide a comprehensive review of the diagnosis and management of acral pigmented lesions. MATERIALS AND METHODS A literature review was performed. The outcomes included were the clinical and dermoscopic features and the management frameworks and considerations for acquired and congenital melanocytic nevi, acral melanosis, nonmelanocytic pigmented lesions, and ALM. RESULTS Original research studies were primarily included. The use of dermoscopy, such as the 3-step algorithm and blotch (irregular), ridge pattern (parallel), asymmetry of structures, asymmetry of colors, furrow pattern (parallel), fibrillar pattern (BRAAFF) checklist, increases the diagnostic accuracy of acral pigmented lesions with high specificity and sensitivity. Short-term digital dermoscopic surveillance can be used to manage acral lesions, and histopathology should be collected when there is a concern for ALM. CONCLUSION The use of dermoscopy and an understanding of how to manage acral lesions may limit the number of biopsies performed on the acral skin, decrease the time to diagnosis, and facilitate early detection of ALM. [ABSTRACT FROM AUTHOR]

As the commercial display market grows, the demand for low-toxicity, highly emissive, and size-tunable semiconducting nanoparticles has increased. Indium phosphide quantum dots represent a promising solution to these challenges; unfortunately, they typically suffer from low inherent emissivity resulting from charge carrier trapping. Strategies to improve the emissive characteristics of indium phosphide often involve zinc incorporation into or onto the core itself and the fabrication of core/shell heterostructures. InP clusters are high fidelity platforms for studying processes such as cation exchange and surface doping with exogenous ions since these clusters are used as single-source precursors for quantum dot synthesis. Here, we examined the incorporation of zinc and gallium ions in InP clusters and the use of the resultant doped clusters as single-source precursors to emissive heterostructured nanoparticles. Zinc ions were observed to readily react with InP clusters, resulting in partial cation exchange, whereas gallium resisted cluster incorporation. Zinc-doped clusters effectively converted to emissive nanoparticles, with quantum yields strongly correlated with zinc content. On the other hand, gallium-doped clusters failed to demonstrate improvements in quantum dot emission. These results indicate stark differences in the mechanisms associated with aliovalent and isovalent doping and provide insight into the use of doped clusters to make emissive quantum dots. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusions Data on the prognostic impact of residual tricuspid regurgitation (TR) after tricuspid transcatheter edge‐to‐edge repair (T‐TEER) are scarce. The aim of this analysis was to evaluate 2‐year survival and symptomatic outcomes of patients in relation to residual TR after T‐TEER.Using the large European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR registry) we investigated the impact of residual TR on 2‐year all‐cause mortality and New York Heart Association (NYHA) functional class at follow‐up. The study further identified predictors for residual TR ≥3+ using a logistic regression model. The study included a total of 1286 T‐TEER patients (mean age 78.0 ± 8.9 years, 53.6% female). TR was successfully reduced to ≤1+ in 42.4%, 2+ in 40.0% and 3+ in 14.9% of patients at discharge, while 2.8% remained with TR ≥4+ after the procedure. Residual TR ≥3+ was an independent multivariable predictor of 2‐year all‐cause mortality (hazard ratio 2.06, 95% confidence interval 1.30–3.26, p = 0.002). The prevalence of residual TR ≥3+ was four times higher in patients with higher baseline TR (vena contracta >11.1 mm) and more severe tricuspid valve tenting (tenting area >1.92 cm2). Of note, no survival difference was observed in patients with residual TR ≤1+ versus 2+ (76.2% vs. 73.1%, p = 0.461). The rate of NYHA functional class ≥III at follow‐up was significantly higher in patients with residual TR ≥3+ (52.4% vs. 40.5%, p < 0.001). Of note, the degree of TR reduction significantly correlated with the extent of symptomatic improvement (p = 0.012).T‐TEER effectively reduced TR severity in the majority of patients. While residual TR ≥3+ was associated with worse outcomes, no differences were observed for residual TR 1+ versus 2+. Symptomatic improvement correlated with the degree of TR reduction. [ABSTRACT FROM AUTHOR]

Objectives. To determine the effect of new therapies and trends toward reduced mortality rates of melanoma. Methods. We reviewed melanoma incidence and mortality among Whites (the group most affected by melanoma) in 9 US Surveillance, Epidemiology, and End Results registry areas that recorded data between 1986 and 2016. Results. From 1986 to 2013, overall mortality rates increased by 7.5%. Beginning in 2011, the US Food and Drug Administration approved 10 new treatments for metastatic melanoma. From 2013 to 2016, overall mortality decreased by 17.9% (annual percent change [APC] = −6.2%; 95% confidence interval [CI] = −8.7%, −3.7%) with sharp declines among men aged 50 years or older (APC = −8.3%; 95% CI = −12.2%, −4.1%) starting in 2014. This recent, multiyear decline is the largest and most sustained improvement in melanoma mortality ever observed and is unprecedented in cancer medicine. Conclusions. The introduction of new therapies for metastatic melanoma was associated with a significant reduction in population-level mortality. Future research should focus on developing even more effective treatments, identifying biomarkers to select patients most likely to benefit, and renewing emphasis on public health approaches to reduce the number of patients with advanced disease. [ABSTRACT FROM AUTHOR]

Magic-sized clusters (MSCs) can provide valuable insight into the atomically precise progression of semiconductor nanocrystal transformations. We report the conversion of an InP MSC to a Cd3P2 MSC through a cation exchange mechanism and attempt to shed light on the evolution of the physical and electronic structure of the clusters during the transformation. Utilizing a combination of spectroscopic (NMR/UV-vis) and structural characterization (ICP-OES/MS/PXRD/XPS/PDF) tools, we demonstrate retention of the original InP MSC crystal lattice as Z-type ligand exchange initially occurs. Further cation exchange induces lattice relaxation and a significant structural rearrangement. These observations contrast with reports of cation exchange in InP quantum dots, indicating unique reactivity of the InP MSC. [ABSTRACT FROM AUTHOR]

This article, built upon individual case studies and an analysis of 3 years of district-wide data for a gifted and talented grant application, identifies the underrepresentation of gifted English learners in gifted and talented programs. The authors argue for (a) reviewing and revising identification procedures and criteria for gifted populations, and (b) professional development for teachers, counselors, and administrators in the area of gifted education in order to better serve gifted English learners who are twice exceptional. [ABSTRACT FROM AUTHOR]

Objectives: To assess the ability of reactive hyperemia–peripheral artery tonometry (RH-PAT) to serve as a surrogate marker of endothelial dysfunction in children with type 1 diabetes (T1D). Research Design and Methods: Forty-four children with T1D [age 14.6 ± 2.7 yr; duration of diabetes 6.01 ± 4 yr; range of diabetes duration 1–16 yr; and hemoglobin A1c (HbA1c) 8.34 ± 1.2%] and 20 children without diabetes (age 14.1 ± 1.5 yr) underwent RH-PAT endothelial function testing after an overnight fast. Height, weight, body mass index (BMI), blood pressure (BP), fasting lipid profile, and glucose level were determined in each child. Children with T1D underwent a second RH-PAT study 4 wk after their initial study to determine the intrapatient variability of the technique. Results: Children with T1D had endothelial dysfunction as evidenced by lower mean RH-PAT scores (1.63 ± 0.5) when compared with children without diabetes (mean RH-PAT score 1.95 ± 0.3) (p = 0.01). Repeat RH-PAT scores were predicted by initial RH-PAT scores (p = 0.0025). Mean intrapatient standard deviation of RH-PAT score was 0.261 and mean coefficient of variation was 14.8. Variations in RH-PAT score were not explained by differences in glucose, HbA1c, BMI, systolic BP, diastolic BP, or lipids. Conclusions: Although larger validation studies are required, RH-PAT is a promising non-invasive technique to assess endothelial function in children with T1D. Non-invasive measures of endothelial dysfunction may provide the additional risk stratification data needed to justify more aggressive primary prevention of cardiovascular disease in children with T1D. [ABSTRACT FROM AUTHOR]

This study examined the association between positive and negative aspects of childrearing history and current parenting and the moderating effect of current stress. Seventy mother–child dyads participated in this study. Mothers provided retrospective reports of childrearing histories and current reports of life stress. Parenting was assessed via maternal self-report and observation. There was modest support for a direct association between positive childrearing experiences and more positive current parenting. Stress moderated the associations between both positive and negative childrearing experiences and current parenting: Stress exacerbated the negative effects of high-conflict histories whereas positive histories protected against the effects of current stress. This study highlights the importance of studying the influence of early experience on parenting within the context of current life stress. [ABSTRACT FROM AUTHOR]

Aims: While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)‐related right‐ heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI. Methods and results: Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76–83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2‐year mortality on Cox regression analyses with Youden index‐derived cut‐offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre‐interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left‐sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right‐sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right‐sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates. Conclusion: In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right‐sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre‐interventional reduction of right‐sided congestion can improve outcomes after TTVI should be established in dedicated studies. [ABSTRACT FROM AUTHOR]

Describes a computerized system for dual-electrode multisweep cyclic voltammetry. Ensuring clay film integrity; Elimination of exposure of the clay film to atmospheric drying or oxidizing conditions during electrolyte switching; Kinetics of change in the film structure.

Dermoscopy has traditionally been used for the diagnosis of neoplasms and more recently in the evaluation of inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating acquired pigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for pigmentary disorders. A literature review was performed on PubMed dating from inception to October 2020. The following pigmentary disorders were included in this study: melasma, solar lentigines, poikiloderma of Civatte, exogenous ochronosis, lichen planus pigmentosus, erythromelanosis follicularis faciei et colli, pigmented contact dermatitis, Riehl's melanosis, postinflammatory hyperpigmentation, erythema dyschromicum perstans, ashy dermatosis, confluent and reticulated papillomatosis, acanthosis nigricans, pityriasis versicolor, tinea versicolor, idiopathic guttate hypomelanosis, and vitiligo. Search terms used included each pigmentary disorder along with the terms "dermoscopy" or "dermatoscopy." Relevant case reports and case series were included. Many pigmentary disorders have unique and distinguishable features on dermoscopy. Given that these disorders can be clinically challenging for clinicians and emotionally distressing for patients, dermoscopy provides an additional, useful tool in the evaluation and assessment process. [ABSTRACT FROM AUTHOR]

We describe three teenage siblings with confluent and reticulated papillomatosis, all presenting during a 6-month period. Two of the three patients had confirmed tinea versicolor, with positive potassium hydroxide scrapings, in association with this entity. This is the largest series of siblings with confluent and reticulated papillomatosis, and the only report describing family members having both confluent and reticulated papillomatosis and tinea versicolor. This report lends further evidence to the hypothesis that confluent and reticulated papillomatosis may be etiologically linked to tinea versicolor, and also suggests a genetic predisposition for it. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the January 30, 2003 article "Peritoneal Dialysis and Epithelial-to-Mesenchymal Transition of Mesothelial Cells," by E. Lara-Pezzi and colleagues.

Background: Recently, a disease modifying therapy has become available for transthyretin amyloid cardiomyopathy (ATTR-CM). A validated monitoring concept of treatment is lacking, but a current expert consensus recommends three clinical domains (clinical, biomarker and ECG/imaging) assessed by several measurable features to define disease progression. Methods: We retrospectively analyzed data of wild-type ATTR-CM patients initiating tafamidis therapy assessed within our local routine protocol at baseline and 6-months follow-up with respect to the frequency of values beyond the proposed thresholds defining disease progression. Additionally, associations of cardiac magnetic resonance (CMR) tomography with clinical domains were examined within a subgroup. Results: Sixty-two ATTR-CM patients were included (88.7% male, mean age 79 years). In total, 16.1% of patients had progress in the clinical and functional domain, 33.9% in the biomarker domain and 43.5% in the imaging/electrocardiography (ECG) domain, with the latter driven by deterioration of the diastolic dysfunction grade and global longitudinal strain. In total, 35.5% of patients showed progress in none, 35.5% in one, 29.0% in two and no patient in three domains, the latter indicating overall disease progression. A subgroup analysis of twenty-two patients with available baseline and follow-up CMR data revealed an increase in CMR-based extracellular volume by more than 5% in 18.2% of patients, with no significant correlation with progress in one of the clinical domains. Conclusions: We provide first frequency estimates of the markers of disease progression according to a recent expert consensus statement, which might help refine the multiparametric monitoring concept in patients with ATTR-CM. [ABSTRACT FROM AUTHOR]

To compare the measurement of aortic diameters using a novel flow-independent MR-Angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT)) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients. This retrospective, single-center analysis included 46 examinations of 32 MFS patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE factor 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists in modified REACT (inner-edge, using multiplanar reconstruction). Intraclass correlation coefficient, Bland-Altman analyses, and Pearson's correlation (r) were used to assess agreement between observers and methods. Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC = 0.95–0.98) and modified REACT (ICC = 0.99–1.00). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.24 ± 3.24 mm vs. 39.63 ± 3.76 mm; p = 0.26; r = 0.78) and the STJ (35.16 ± 4.47 mm vs. 35.37 ± 4.74 mm; p = 0.552; r = 0.87). AoA diameters determined by TTE were larger than in modified REACT (34.29 ± 5.31 mm vs. 30.65 ± 5.64 mm; p < 0.01; r = 0.74). The mean scan time of modified REACT was 05:06 min ± 02:47 min, depending on the patient's breathing frequency and heart rate. Both TTE and modified REACT showed a strong correlation for all aortic levels; however, at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE, modified REACT represents an attractive method to depict the thoracic aorta in MFS patients. • TTE and modified REACT showed excellent interobserver reliability for measurements of the proximal thoracic aorta. • There was a strong correlation for all levels of measurement between TTE and modified REACT. At the SV and STJ there was no significant difference of measured diameters between both techniques whereas at the AoA, diameters were significantly larger using TTE. • Given the high agreement between both techniques, TTE and modified REACT can be used for surveillance of aortic diameters in MFS. [ABSTRACT FROM AUTHOR]

Prenatal diagnosis of congenital heart disease (CHD) often leads to anxiety, depression, and traumatic stress in expectant mothers, with long-term implications for the child and family. However, psychosocial intervention is rarely incorporated into prenatal care. HEARTPrep is a virtually delivered psychosocial intervention aimed at reducing distress and social isolation and increasing parenting self-efficacy and hope for mothers expecting a baby with CHD to promote long-term child/family well-being. This study evaluated the feasibility and acceptability of HEARTPrep. Participants were mothers receiving cardiology care for a fetal CHD diagnosis. Partners could participate with the mother. HEARTPrep was delivered through a mobile app and telehealth. Feasibility was assessed through enrollment/retention rates. Acceptability was assessed through 20 Likert-scale and five open-ended questions. Of 39 recruited mothers, 35 (90%) enrolled. Half of partners (48%) also participated. Twenty-seven of 35 enrolled mothers (77%) completed HEARTPrep. On a scale from 0 (Not at All) to 4 (Very), mean item acceptability scores ranged from 3.5 to 3.9. Mothers reported HEARTPrep helped them feel less distressed (mean: 3.74), less alone (3.84), more prepared (3.89), and more hopeful (3.84). Opportunities to process emotions, develop coping skills, learn with their partner, navigate relationships, understand they are not alone, connect with peer support, access resources, and prepare for stressors were described as helpful. HEARTPrep is feasible and acceptable for mothers expecting a baby with CHD. Future research will evaluate its efficacy in preventing/reducing maternal mental health problems and improving postnatal clinical outcomes. [ABSTRACT FROM AUTHOR]

Jiang and co-workers use high resolution STM to investigate the reaction and self-assembly of (3,6-dibromo-9,10-phenanthrenequinone, or DBPQ) molecules on Ag (100) and Ag (110) surfaces in order to understand the mechanism of bottom-up assembly on surfaces.[31] They show that, through the inclusion of multiple functional groups within a precursor molecule, it becomes possible to fabricate new low-dimensional materials with unique chemical, physical, and electronic properties. Herbst and Fransson consider the core-valence separation approximation that is often used in the calculation of core-level spectra.[5] They show how to quantify the errors in this approximation, thereby opening the door to error-quantified predictions relevant to x-ray spectroscopy. 153(16), 164108 (2020).10.1063/5.0019557 5 M. F. Herbst and T. Fransson, "Quantifying the error of the core-valence separation approximation", J. Chem. Phys. Zhu and co-workers tackle this problem for a model system containing a 2D semiconductor heterojunction and show convincingly the efficient hot electron transfer from photoexcited MoTe SB 2 sb to WS SB 2 sb .[30] This finding provides important insight into the competition between hot electron cooling and transfer at 2D semiconductor interfaces and suggests an intriguing possibility for the exploration of hot electron devices. [Extracted from the article]

Changes in melanocytic nevi during pregnancy are frequently attributed to the new hormonal milieu and are dismissed without concern for malignancy. Recent studies suggest that pregnancy itself does not induce significant change in nevi, and delays in the assessment of changing moles may contribute to the often more advanced nature of melanomas diagnosed during or soon after pregnancy. Nevi on the breasts and abdomen can grow as a result of skin expansion, but studies have found no significant changes in nevi located in more stable areas such as the back or lower extremities. There is also insufficient evidence to support the notion that nevi darken during pregnancy. As such, any changing nevus that would raise concern for malignancy in a nonpregnant patient should do so in a pregnant patient as well. Pregnancy can, however, induce physiologic pigmentary changes that are often worrisome to both patients and physicians. These benign changes include melasma, pigmentary demarcation lines, secondary areola, and linea nigra as well as other less common findings. It is important for physicians to recognize these changes as physiologic to provide adequate reassurance to their patients and avoid unnecessary stress. [ABSTRACT FROM AUTHOR]

Examines the relation between the feeding disturbances in children and the abnormal eating habits and attitudes among their mothers. Possibility that abnormal attitudes to body shape and weight and disturbed eating habits among mothers may play a role in feeding disturbances in children.

A bibliometric analysis was performed to examine the occupational therapy peer-reviewed literature addressing interventions for children and adolescents with mental health disorders (1980–2019). The search strategy yielded 82 articles that have not produced significant support for the profession's role in this practice area, have not been well-cited, and may not be readily accessible by stakeholders. A third of this literature addressed children with ADHD using sensory-based approaches. Depression, anxiety, and bipolar disorder were addressed comparatively less. The profession must increase advocacy to enhance awareness of therapists' role in this practice area and engage in research supporting practice. [ABSTRACT FROM AUTHOR]

Objectives: Pedunculated lipofibromas are soft, compressible, skin-colored nodules that typically present as an acquired solitary lesion, predominantly located on the buttocks and thighs. We aimed to differentiate between pedunculated lipofibromas and nevus lipomatosus superficialis. Although benign, this may be important as treatment options vary.Methods: We describe 3 cases of solitary pedunculated lipofibromas occurring in older, obese adults that required clinicopathologic correlation for the correct diagnosis.Results: The histopathologic features of pedunculated lipofibromas include a broad-based lesion with aggregates of mature adipocytes extending upwards into the dermis without an associated inflammatory infiltrate. The primary histopathologic differential diagnoses include fibroepithelial polyps with adipocytes and nevus lipomatosus superficialis, which is more frequently found in children or young adults and is typically characterized clinically by multiple lesions with a cerebriform to verrucoid surface.Conclusions: While the precise relationship between pedunculated lipofibromas and nevus lipomatosus is still unknown, we propose using pedunculated lipofibroma as a more specific clinical term to refer to solitary pedunculated or broad-based fatty lesions with a smooth surface that occur in older patients and in a wide anatomic distribution. [ABSTRACT FROM AUTHOR]