"Clear cell" atypical fibroxanthoma

An 87-year-old man with extensive solar damage presented with a 2-month history of a dome-shaped, crusted lesion on the dorsum of the left hand. Microscopically, the tumor consisted of fascicles of spindle cells with bizarre nuclei and clear, vacuolated cytoplasm. Histochemical, immunohistochemical, and ultrastructural features supported the diagnosis of atypical fibroxanthoma. There was no evidence of metastatic disease. The lesion was completely excised, and there has been no recurrence in 3 months of observation. This unusual "clear cell" variant of atypical fibroxanthoma must be distinguished from other clear cell tumors, such as metastatic renal cell carcinoma, clear cell eccrine carcinoma, and clear cell sarcoma (malignant melanoma) of soft parts. Although atypical fibroxanthoma is usually cured by complete surgical excision, metastases have been reported.     

Diet Quality and Cognitive Performance in Australian Adults Aged 55–85 Years: A Cross-Sectional Analysis of the Hunter Community Study Cohort

There is a lack of evidence to determine if diet quality is associated with cognitive performance in older adults. Therefore, the aim of this study was to examine whether diet quality is associated with cognitive performance among older adults. A cross-sectional, secondary analysis of baseline data from the Hunter Community Study (HCS), comparing diet quality, measured using the Australian Recommended Food Score (ARFS), along with validated cognitive performance instruments the Audio Recorded Cognitive Screen (ARCS) and the Mini-Mental State Examination (MMSE) were undertaken in adults aged 55–85 years, living in Newcastle, NSW, Australia. Adjusted linear regression analyses showed that, compared with the lowest ARFS quintile, those in the highest quintile had an ARCS score 5.883 units greater (p < 0.001; R² = 0.0098). Furthermore, when quintiles of ARFS score were tested against each ARCS sub-scale score, statistically significant associations were observed with the greatest effect for the Memory (β = 4.055; p = 0.001; R² = 0.0065) and Attention (β = 4.136; p = 0.002; R² = 0.0047) domains. No statistically significant associations were observed between quintiles of ARFS and MMSE score in the adjusted linear regression analyses. In conclusion, a positive association was observed between diet quality and cognitive performance within this sample of older Australian adults. Further investigation of the above association over time, when follow-up data becomes available, in longitudinal analysis is recommended.     

A diffusion theory model of spatially resolved, steady-state diffuse reflectance for the noninvasive determination of tissue optical properties in vivo.

A model based upon steady-state diffusion theory which describes the radial dependence of diffuse reflectance of light from tissues is developed. This model incorporates a photon dipole source in order to satisfy the tissue boundary conditions and is suitable for either refractive index matched or mismatched surfaces. The predictions of the model were compared with Monte Carlo simulations as well as experimental measurements made with tissue simulating phantoms. The model describes the reflectance data accurately to radial distances as small as 0.5 mm when compared to Monte Carlo simulations and agrees with experimental measurements to distances as small as 1 mm. A nonlinear least-squares fitting procedure has been used to determine the tissue optical properties from the radial reflectance data in both phantoms and tissues in vivo. The optical properties derived for the phantoms are within 5%-10% of those determined by other established techniques. The in vivo values are also consistent with those reported by other investigators.     

The medical liability crisis: the New York experience

The past 15 years have not been easy for the doctors who manage Medical Liability Mutual. There have been many frustrations and setbacks, and at times the predictors of doom for MLMIC seemed to be correct. Despite all the difficulties, the board of directors has never deviated from its original basic principles: (1) to attempt to settle meritorious claims rapidly and to resist totally those claims without merit; (2) to invest funds with caution and prudence, while achieving the best possible return on that investment; (3) to reduce medical injury and enhance patient safety; and (4) to make every effort to change a system that does not serve the public and threatens our health care system. The next five years may well be even more hectic than the past 15 have been. We do not know the reasons for the recent apparent improvement, and the situation may well deteriorate again. It is to be hoped that major changes that will benefit the public as a whole will occur, and that in the future the concerns of professional liability will not consume as much of our time and resources as they do at present.     

Attenuation of the cutaneous blood flow response during combined exercise and heat stress

Skin blood flow (SkBF) was measured in six male subjects using laser-Doppler velocimetry, with zero-gradient auditory canal temperature (T_ac) used as an index of body core temperature (T_c). Subjects performed incremental, upright cycling commencing at 40% peak power ( _peak: 10 min), increasing every 4 min by 5 % _peak thereafter. Trials were conducted in hot (ambient temperature (T_a) 36.7 ±0.2°C, relative humidity (rh) 46.1 ±3.2%; _peak ±S.D.), and neutral environments (T_a 19.6 ±0.3°C, rh 50.2 ±1.4%). SkBF increased with T_ac in all subjects. Attenuation of SkBF occurred at the same T_ac, relative SkBF and cardiac frequency (f _c) between environments, but at a lower exercise intensity (40.8 ±0.8% versus 55.8 ±3.0% _peak) in the hot environment (p<0.05). Data indicate that T_c thresholds for SkBF attenuation may exist. However, it is suggested that attenuation thresholds coincided with a reduced central blood volume, which may occur at a critical level of cutaneous blood pooling.