Thin malignant melanomas with regression and metastases

The significance of partial regression in thin malignant melanomas (0.76 mm or less) of the skin was evaluated to determine if the regression was associated with the later development of metastases in patients who previously were considered to have a favorable prognosis. Of 575 patients with primary cutaneous melanoma treated and followed up by the Division of Surgical Oncology at the University of Illinois, Chicago, we found that 103 (18%) had tumors that measured less than 0.76 mm. Of these, 30 (29%) showed histologic evidence of partial regression. In six (20%) of the 30 patients, visceral metastases developed and the patients died. All six had more than 77% regression of their primary tumors. Of the remaining 24 patients, only one had regression greater than 77% and she is still alive three years after diagnosis. Most of these 24 (83%) patients had regression of less than 50% (mean, 29.9%). No metastasis occurred in the 73 patients who had thin melanomas without histologic evidence of regression. It is apparent from this study that patients with thin melanomas who show partial regression cannot be included in the "low-risk" group if the extent of regression is 75% to 80% or more.     

The prevalence of refractive errors among schoolchildren in Dezful, Iran

AIM: To determine the prevalence of refractive errors among schoolchildren in urban and rural areas of Dezful County, Iran. METHODS: In a cross-sectional study, using random cluster sampling, 5721 Dezful schoolchildren were selected from 39 clusters. The participants in the study totalled 5544; 3673 elementary and middle school students and 1871 high school students. For the former group, cycloplegic refraction and for the latter, non-cycloplegic refraction was tested. In all participants, uncorrected visual acuity and best corrected visual acuity were determined, and those with a visual acuity of 20/40 or worse, underwent a complete ophthalmic examination to determine the cause of visual impairment. A spherical equivalent of -0.5 diopter (D) or worse was defined as myopia, +2.0 D or more was defined as hyperopia, and a cylinder refraction greater than 0.75 D was considered astigmatism. RESULTS: The uncorrected visual acuity was 20/40 or worse in the better eye of 224 schoolchildren (3.8% of participants). This figure (percentage) was 14 (0.03%) based on their best corrected visual acuity and 96 (1.7%) with their presenting vision. According to results of cycloplegic refraction, 3.4% (95% confidence interval (CI), 2.5 to 4.4) of the primary and middle school students were myopic and 16.6% (95% CI, 13.6 to 19.7) were hyperopic. For high school students, these rates were 2.1% (95% CI, 0.7 to 3.5) and 33.0% (95% CI, 24.9 to 41.1), respectively, with non-cycloplegic refraction. In the multivariate logistic regression for primary and middle school students, myopia was correlated with age (p = 0.030), and hyperopia was correlated with age (p<0.001) and area of residence (p = 0.007). In high school students, hyperopia again showed a correlation with their area of residence (p = 0.029). CONCLUSION: The present study reveals the considerable prevalence rates of refractive errors among schoolchildren in Dezful County and the high rate of an unmet need for their correction. Although myopia is not very prevalent, the high rate of hyperopia in the studied population emphasises its need for attention.     

Temporal limits of long-range phase discrimination across the visual field

When two flickering sources are far enough apart to avoid low-level motion signals, phase judgment relies on the temporal individuation of the light and dark phases of each source. The highest rate at which the individuation can be maintained has been referred to as Gestalt flicker fusion [Van de Grind, W. A., Grüsser, O. -J., & Lunkenheimer, H. U. (1973). Temporal transfer properties of the afferent visual system. Psychophysical, neurophysiological and theoretical investigations. In R. Jung (Ed.), Handbook of sensory physiology (Vol. VII/3, pp. 431-573). Berlin: Springer, Chapter 7] and this has been taken as a measure of the temporal resolution of attention [Verstraten, F. A., Cavanagh, P., & Labianca, A. T. (2000). Limits of attentive tracking reveal temporal properties of attention. Vision Research, 40, 3651-3664; Battelli, L., Cavanagh, P., Intriligator, J., Tramo, M. J., Henaff, M. A., Michel, F., et al. (2001). Unilateral right parietal damage leads to bilateral deficit for high-level motion. Neuron, 32, 985-995]. Here we examine the variation of the temporal resolution of attention across the visual field using phase judgments of widely spaced pairs of flickering dots presented either in the upper or lower visual field and at either 4 degrees or 14 degrees eccentricity. We varied inter-dot separation to determine the spacing at which phase discriminations are no longer facilitated by low-level motion signals. Our data for these long-range phase judgments showed that temporal resolution decreases only slightly with increased distance from center of gaze (decrease from 11.4 to 8.9 Hz between 4 degrees to 14 degrees ), and does not differ between upper and lower visual fields. We conclude that the variation of the temporal limits of visual attention across the visual field differs markedly from that of the spatial resolution of attention.     

Erythema Toxicum Neonatorum: An Immunohistochemical Analysis

Erythema toxicum neonatorum is a benign rash of unknown etiology, present to various degrees in most term newborns and characterized by an accumulation of eosinophils in dermal lesions. The recruitment of leukocytes to tissues implicates the involvement of adhesion molecules, cytokines, and chemokines. We therefore performed immunohistochemistry on punch biopsy specimens from cutaneous lesions of ten 1-day-old infants with erythema toxicum using specific monoclonal antibodies directed against a variety of adhesion molecules, cytokines, chemokines, and cell type-specific membrane markers. Biopsy specimens of noninflamed skin from four matched newborns and four adults served as controls. The immunohistologic features of erythema toxicum in all 10 infants included a strong staining of the adhesion molecule E-selectin in the vessel wall and the presence of numerous inflammatory cells that were identified as dendritic cells (CD1a, CD83, HLA-DR, CD40, and ICAM-1 positive), eosinophils (EG2 positive), neutrophils (CD15 positive), macrophages (CD14, CD68, and Mac387 positive), and E-selectin-expressing cells. Furthermore, the lesions showed a high incidence of the proinflammatory cytokines interleukin (IL)-1alpha and IL-1beta and of the chemokines IL-8 and eotaxin. This immunologic activity was reduced or absent in noninflamed skin from newborn controls and adults. We conclude that there is an accumulation and activation of immune cells in the lesions of erythema toxicum, also present in noninflamed skin of 1-day-old infants, but to a lower level. The physiologic significance of the rash remains to be elucidated.     

Ocular higher-order aberrations and mesopic pupil size in individuals screened for refractive surgery

AIM: To study the distribution of ocular higher-order aberrations(HOAs) and mesopic pupil size in individuals screened for refractive surgery. METHODS: Ocular HOAs and mesopic pupil size were studied in 2 458 eyes of 1 240 patients with myopia, myopic astigmatism and compound myopic astigmatism and 215 eyes of 110 patients with hyperopia, hyperopic astigmatism and compound hyperopic astigmatism using the Zywave aberrometer (Busch& Lomb). All patients had correctable refractive errors without a history of refractive surgery or underlying diseases. Root-mean-square values of HOAs, total spherical aberration, total coma and mesopic pupil size were analyzed. Ocular HOAs were measured across a ≥ 6.0 mm pupil, and pupil size measurements were performed under the mesopic condition. RESULTS: The mean values of HOAs, total spherical aberration and total coma in the myopic group were 0.369μm, ±0.233, 0.133± 0.112μm and 0.330±0.188μm, respectively. In the hyperopic group the mean values of HOAs, total spherical aberration and total coma were 0.418μm ±0.214, 0.202±0.209μm and 0.343±0.201μm, respectively. Hyperopes showed greater total HOAs (P<0.01) and total spherical aberration (P<0.01) compared to myopes. In age-matched analysis, only the amount of total spherical aberration was higher in the hyperopic group (P=0.05). Mesopic pupil size in the myopic group was larger (P≤0.05). CONCLUSION: The results suggested that significant levels of HOAs were found in both groups which are important for planning refractive surgeries on Iranians. There were significantly higher levels of total spherical aberration in hyperopes compared to myopes. Mesopic pupil size was larger in myopic group.     

Gene expression profiling reveals alteration of caspase 6 and 14 transcripts in normal skin of keloid-prone patients

Excessive scar formation in keloids points to altered tissue modeling and repair mechanisms. Dysregulation of cytokine and apoptotic cascades and their downstream signaling pathways might have a role in keloid development. Total RNA was isolated from biopsied keloidal tissue and adjacent normal skin of black patients, white patient’s scars, and normal skin of black and white patients, with normal wound healing. Apoptosis, cytokine and NFkB pathway microarrays were used to study and compare gene expression levels. Real-time PCR was used to verify microarray results in original samples and a separate, validation-set of samples. Significant differences were observed in the expression levels of members of caspase, cytokines and MAP kinase pathways, between the normal skin of keloid-prone and normal skin of keloid-resistant patients. Specifically, expression of caspase 6, and caspase 14 genes were different between normal skin of keloid-prone individuals and normal skin of keloid-resistant patients. Our results suggest that normal skin of keloid-prone individuals constitutively expresses a distinct gene profile which might contribute to their susceptibility to develop keloids.     

Severe Hypoglycemia Due to Cryptic Insulin Use in a Bodybuilder

Background

Bodybuilding is a demanding sport, which requires high-volume, high-resistance weight training and augmented nutritional intake, toward an increase of overall body muscle mass accompanied by an overall decrease of body fat percentage and mass. Among bodybuilders, the use of various legal and illegal supplements is common. These supplements may be naturally occurring or man-made.

Effects of upper-body resistance exercise training on serum nesfatin-1 level,insulin resistance,and body composition in obese paraplegic men

Background

As a recently discovered adipokine, nesfatin-1 is conducive to insulin sensitivity, lipid profile, energy balance, and probably obesity.

Extraction and immunochemical characterization of cholecystokinin-like peptides from pig and rat brain

Two major classes of immunoreactive cholecystokinin peptides (iCCK) have been identified in rat and pig brains: (i) large basic peptides (big iCCK) resembling the 33-amino acid porcine cholecystokinin (pCCK33) in size and charge; (ii) small acidic peptides (small iCCK) resembling the COOH-terminal fragments of CCK. Boiling 0.1 M HCl maximally extracts big iCCK; boiling 0.1 M NaOH maximally extracts small iCCK. The differences in hormonal forms removed by these extractants are not likely to be due to enzymatic conversion during the extraction procedures. Fractionation on Sephadex G-50 and starch gel electrophoresis combined with radioimmunoassay using three antisera of different specificities--(i) directed towards the NH2 terminus of pCCK33, (ii) produced by immunization with COOH-terminal fragment CCK8, (iii) produced by immunization with COOH-terminal fragment CCK4--are consistent with the hypothesis that a major fraction of big iCCK may represent intact cholecystokinin with a COOH-terminal extension, as has recently been suggested for gastrin, a molecule having a COOH-terminal pentapeptide identical with that of cholecystokinin.