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Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P<0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.

Immune checkpoint inhibitor (ICI) therapy has reshaped the treatment landscape in many cancers including non-small cell lung cancer (NSCLC). ICI-therapy can lead to a diverse array of immune-related adverse effects (irAEs), and prompt recognition and management are key to successful treatment. With wide-spread use of ICI therapy in clinical practice, rare irAEs are being increasingly recognized. This report documents a patient with advanced NSCLC who developed pembrolizumab-associated sarcoidosis with multiorgan involvement. Multidisciplinary management led to timely diagnosis and treatment, leading to improvement in symptoms. This case raises awareness of sarcoidosis as a rare side effect of pembrolizumab., (Copyright © 2022. Published by Elsevier Inc.)

A 56-year-old Caucasian male with a history of chronic plaque psoriasis, primary sclerosing cholangitis status-post liver transplant on tacrolimus, and ulcerative colitis on infliximab developed a progressive erythematous eruption with associated fatigue, anorexia, myalgias, and arthralgias. On two separate occasions, his skin biopsy demonstrated a lichenoid interface dermatitis (LID). Despite multiple courses of oral prednisone, topical steroids, and a short course of hydroxychloroquine, his symptoms continued to relapse and remit. When a temporal association between increasing his infliximab dose and the global progression of his disease was identified, he was ultimately diagnosed with a TNF-α inhibitor-induced psoriasis flare. Despite the patient’s long-standing history of psoriasis, a plausible psoriasis rebound reaction after systemic steroids was not strongly considered in light of his histopathology. Though lichenoid interface dermatitis is a commonly reported histologic finding in patients on TNF-α inhibitors, it has scarcely been reported in patients with psoriasiform eruptions clinically.

Brine injection of natural proteases, dried egg white (EW), and dried potato extract (PE), was investigated as a means to prevent softening during cooking of Pacific whiting fillets. Treatments included fillets injected with Water (W), 3% sodium chloride and 3% sodium tripolyphosphate brine (B), B with 0.1% xanthan gum (B XG ), B with 1%, 2%, or 3% EW (B 1-3EW ), B with 1%, 2%, or 3% PE (B 1-3PE ) or non-injected (NI). Non-injected Pacific cod (Cod) was also utilized as a reference for texture analysis. Fillets were subsequently cooked using cooking protocol 1 (90 °C for 20 min) or cooking protocol 2 (60 °C for 30 min then 90 °C for 20 min). Cooked fillet pH, moisture, total protein, total extractable protein (TEP), total non-extractable protein (TNEP), texture profile analysis (TPA), and electrophoretic pattern (SDS-PAGE) were measured. Cooking protocol 2 significantly reduced moisture, increased total protein, TEP and TNEP. Loss of moisture suggested cooking protocol 2 promoted proteolysis. Electrophoretic evaluations of the fillets treated with the cooking protocol 2 confirmed proteolysis was enhanced by cooking protocol 2 and myosin band integrity was protected in fillets containing natural protease inhibitors. For TPA, there was no significant difference between protease inhibitor types although means for B EW did trend higher than B PE . However, PCA analysis clearly demonstrated B 2EW and B 3EW fillets were most similar to Cod. Results demonstrated brine injection with protease inhibitors prevented fillet softening during cooking., Practical Application: Texture softening in fish has typically been addressed by diverting product to lower-value minced applications where ingredients can be blended-in to counteract softening caused by enzymes. Investigations demonstrate feasibility of brine injection of protease inhibitor ingredient, dried egg white, to preserve protein integrity during cooking. Dried potato extract required a suspension aide, xanthan gum, in order to become sufficiently suspended in the brine for injection. Dried potato extract was able to inhibit protease activity, however, the suspension aide negatively impacted protein-protein interactions during cooking. An alternative suspension aide is therefore required for dried potato extract., (© 2018 Institute of Food Technologists®.)

The Biofish-300 HIS method is a simple, reliable, and specific enzymatic biosensor for the detection of histamine. This technology is highly specific and selective and allows quantification of histamine in fishery products (fresh/frozen and processed) in a short time frame (2-3 min). Histamine in raw tuna, raw mackerel, raw sardine, raw anchovy, boiled tuna, canned tuna in water, canned tuna in oil, canned mackerel in tomato sauce, canned pickled sardine, and canned salted anchovy was analyzed using a water-based extract. Matrix-specific assay procedures and calibration curves were used to enable analyses to be carried out across multiple sample types. The performance of this assay was examined using samples that were naturally contaminated (reference materials and interlaboratory studies) and spiked with histamine. All data were judged against previously established acceptance criteria. Performance measures were evaluated for linearity, selectivity, matrix, lot consistency, and robustness. Results produced in all performance measures, except robustness, were within acceptable ranges. Out-of-range robustness results reflected deviation in sample volume compared to the standard assay procedures. Positive interferences from the presence of agmatine were shown.

This review aims at summarizing the findings of studies published over the past 15 years on the application of modified atmosphere (MA) systems for shelf life extension of fish and fishery products. This review highlights the importance of CO₂ in the preservation of seafood products, and underscores the benefits of combining MA technology with product storage in the superchilled temperature range. It is generally accepted that MA technology cannot improve product quality and should not be utilized as a substitute for good sanitation and strict temperature control. Benefits derived from application of MA, however, can significantly impact preservation of product quality and it subsequent shelf-life. For this reason, this review is the first of its kind to propose detailed handling and quality guidelines for fresh fish to realize the maximum benefit of MA technology.

Background: Cutaneous findings associated with hemophagocytic lymphohistiocytosis (HLH) remain largely undescribed in the literature, yet are substantial and correlative with disease course., Objective: To catalog the clinical findings of cutaneous eruptions associated with HLH., Methods: We performed a retrospective chart review of patients meeting the criteria for HLH at two hospitals over 5 years. All patients meeting the criteria for HLH as defined by the HLH-2004 protocol were included., Results: Cutaneous lesions were categorized based on clinical presentations and histology. Lesions independent of immunocompromised state were observed, including pyoderma gangrenosum, panniculitis, morbilliform eruptions, Stevens-Johnson syndrome, atypical targetoid lesions and bullae. Histologic findings were non-specific., Conclusion: Cutaneous eruptions as a consequence of HLH are variable in presentation and identified as a diagnosis of exclusion. Findings are both primarily and secondarily induced by altered immunity. Further study is needed to allow better understanding of the immunopathogenesis involved.

By-products obtained from winemaking processes still contain large amounts of phenolic compounds, especially phenolic acids, flavanols, flavonols, stilbenes, and flavonoids. Enzymatic hydrolysis was used for determination and characterization of phenolic acids, flavanols, flavonols, and stilbenes. Characterization of the flavonoids was achieved using acid hydrolysis with 0.1% hydrochloric acid. In addition, organic solvents as 50% methanol, 70% methanol, 50% acetone, 0.01% pectinase, and 100% petroleum ether were also evaluated. Reversed phase high-performance liquid chromatography (RP-HPLC) with diode array detector was used to identify phenolic compounds. Internal standard quantification was implemented using a five points of the UV-visible absorption data collected at the wavelength of maximum absorbance. A total of 16 phenolic compounds were determined. The content differed from 1.19 to 1124 mg kg(-1). Outcomes from HPLC study showed that gallic acid, (+) catechin hydrate, and (-) epicatechin gallate were the major phenolic compounds presented in the sample. Malvidin and pelargonidin 3-O-glucoside were the major anthocyanins monoglucosides.

Phenolic acids, flavanols, flavonols and stilbenes (PAFFS) were isolated from whole grapes, juice, or pomace and purified using enzymatic hydrolysis. Only anthocyanin mono-glucosides and a few of the oligomers from Cynthiana grape (Vitis aestivalis) were analysed. Flavonoid-anthocyanin mono-glucosides (FA) were isolated using methanol/0.1% hydrochloric acid extraction. In addition, crude extractions of phenolic compounds from Cynthiana grape using 50% methanol, 70% methanol, 50% acetone, 0.01% pectinase, or petroleum ether were also evaluated. Reverse phase high performance liquid chromatography (RP-HPLC) with photodiode array (PDA) detector was used to identify phenolic compounds. A method was developed for simultaneous separation, identification and quantification of both PAFFS and FA. Quantification was performed by the internal standard method using a five points regression graph of the UV-visible absorption data collected at the wavelength of maximum absorbance for each analyte. From whole grape samples nine phenolic compounds were tentatively identified and quantified. The individual phenolic compounds content varied from 3 to 875 mg kg⁻¹ dry weight. For juice, twelve phenolic compounds were identified and quantified. The content varied from 0.07 to 910 mg kg⁻¹ dry weight. For pomace, a total of fifteen phenolic compounds were tentatively identified and quantified. The content varied from 2 mg kg⁻¹ to 198 mg kg⁻¹ dry matter. Results from HPLC analysis of the samples showed that gallic acid and (+)-catechin hydrate were the major phenolic compounds in both whole grapes and pomace. Cyanidin and petunidin 3-O-glucoside were the major anthocyanin glucosides in the juice., (Published by Elsevier Ltd.)

This study was conducted using response surface methodology to predict fluid loss from injected beef strip steaks as influenced by levels of salt and sodium phosphates (SP) in the injection brine. Also, a beef-based dehydrated beef protein (DBP) water binding ingredient was evaluated. Paired U.S. select beef strip loins were quartered before being injected with 110% of initial weight with brines containing various concentrations of salt and SP (CON) or salt, SP and 5% DBP. Steaks were sliced, overwrapped and stored in the dark for 4d. Purge values ranged from 0.6% to 4.6% for CON and 0.3% to 2.1% for DBP. Fluid losses when accounting for the fluid lost from injection to slicing were as high as 6.8% for CON brines, but only 2.8% for DBP brines. The equations generated here and the DBP product could help producers achieve acceptable purge while reducing sodium use., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Unlabelled: Muddy and/or musty off-flavors in farmed-raised catfish occur as a result of the absorption of geosmin (GEO) and 2-methylisoborneol (MIB), compounds produced by algae. Previous research suggests the acid pH-shift method may be able to reduce off-flavors to produce a consumer acceptable product. The objective of this research was to evaluate application of the acid pH-shift method using a shaker sieve for protein recovery and to evaluate consumer acceptability of a resultant batter-coated fried nugget-like catfish product. Farm-raised catfish were either allowed to depurate (control) or treated with 1 ppb GEO or MIB. Fillets from each replicate were collected and ground and treated by the acid pH-shift process. Samples from all treatments and replicates were evaluated for residual GEO and MIB. In addition, batter-coated fried catfish samples were prepared for a consumer sensory evaluation. Results demonstrated that the pH-shift process decreased moisture, ash, and collagen content of catfish fillet tissue (P < 0.05). Flavor of control samples was preferred (P < 0.05). Texture of catfish samples treated by the pH-shift process was preferred (P < 0.05). Results demonstrate the pH-shift process can be utilized to reduce off-flavors and increase the acceptability of a processed catfish product., Practical Application: Use of a sieve as an economic alternative for the pH-shift process was evaluated for removing off-flavors from catfish. Difficulties were encountered with regard to protein recovery using the sieve and suggestions are made to, perhaps, make the process more applicable for a sieve-based recovery step. The process as described reduced off-flavors, but only 2-fold suggesting the process would work best on catfish near or just over off-flavor thresholds. Results also indicated the pH-shift process could be used to improve texture of a fried catfish product designed to be similar to chicken nuggets., (© 2012 Institute of Food Technologists®)

A dehydrated beef protein (DBP) was evaluated as a replacement for the phosphate added to beef injection brines. U.S. Select strip loins (n=20) were injected to 110% of their initial weight with a brine containing 3.6% salt and 4.5% sodium phosphate (CON) or 3.6% salt and 5% dehydrated beef protein (DBP). DBP loins had less fluid loss after 30 min. Steaks from both treatments lost similar amounts of fluid during storage. Total fluid loss was lower for DBP injected product. Lipid oxidation (TBARS) products were 0.23-0.60 mg/Kg higher for DBP steaks. DBP steaks were slightly less red than CON steaks according to instrumental measurements. Sensory panel evaluation, however, indicated no differences in redness. DBP steaks were less tender according to trained sensory panel. Results indicated the DBP to be effective in increasing brine retention and a viable alternative to phosphates when used in brines injected into beef strip steaks., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Paired U.S. Department of Agriculture Select strip loins were injected with either a conventional brine (4.5% potassium and sodium polyphosphate blend [Brifisol 750], 3.6% NaCl, 1% Herbalox seasoning HT-S, and 90.9% ice water) or an ammonium hydroxide (AH) brine (1% AH, 3.6% NaCl, 1% Herbalox seasoning HT-S, and 94.4% ice water). The steaks were sliced, high-oxygen modified atmosphere packaged, placed at 5°C in dark storage for 5 days, and then transferred to a retail display at 5°C for another 14 days. Steaks injected with AH brine appeared to have lower counts of psychrotrophic, mesophilic, and gram-negative bacteria. Immediately after injection, there was ∼1 log CFU/g difference between treatments in gram-negative bacterial counts. No differences in coliform and lactic acid bacterial counts were found.

Select beef loin pairs (n = 10) were injected (10% pump) with brine containing either 4.5% sodium-based phosphates, (CON), or 1% ammonium hydroxide treatment (AHT). Both brines also contained 3.6% NaCl and 1% Rosemary Herbalox. Steaks cut from loins were high oxygen (80% O(2)/20% CO(2)) modified atmosphere packaged, stored 4 d at 4 °C in the dark to simulate transportation, and then placed in retail display for 14 d (4 °C). On day 0, 7, and 14 of retail display steak properties were measured. Purge from AHT steaks was higher than CON (P < 0.05). Panelists were not able to visually discriminate between AHT and CON steaks through the first 6 d of retail display. After day 6, panelists rated AHT steaks higher for muscle color, percent discoloration, and overall color. Steaks from both treatments started at day 0 retail display with similar total plate counts (P > 0.05). Microbial counts increased more rapidly for AHT steaks than CON steaks (P < 0.05). AHT and CON steaks were not different in terms of lipid oxidation through day 7 retail display. By day 14 retail display CON steaks were above the threshold for consumer perception of oxidized flavors in fresh meat. However, results also indicated the AHT and CON steaks were no longer acceptable by day 14 in terms of color, were questionable in terms of microbial load, and likely were beyond their reasonable shelf life. Based on retail display properties, results indicated 1% AHT could successfully replace 4.5% SP in a meat injection brine. Practical Application: The research in this report compares steaks that have been injected with a commercial brine formulated with SP to steaks that have been injected with a brine, where the SP in the formulation are replaced with 1% AHT. Ammonium hydroxide is an USDA-FSIS approved ingredient in brines injected into fresh meats. Successful replacement of sodium phosphate with ammonium hydroxide would allow processors to significantly reduce the sodium content of injected fresh meat.

The impact of 2 different brines on the palatability and tenderness of select beef strip loin steaks was evaluated. Brines were differentiated by the type of alkaline agent, 4.5% sodium-based phosphate (control brine; CON) or 1% ammonium hydroxide (ammonium hydroxide treatment; AHT), incorporated into the formula. Injected steaks were placed in high oxygen (80% O(2)/20% CO(2)) MAP, stored 4 d at 4 °C in dark storage to simulate transportation, and then placed in retail display. Steaks were selected randomly on day 0, 7, and 14 retail display to measure pH, cook loss, shear force, and sensory characteristics. The pH for AHT steaks (pH 5.96) was slightly higher than CON steaks (pH 5.86; P < 0.05). Cook loss was lower (21%) for CON than AHT steaks (23%). There was neither a treatment nor day effect on tenderness as measured by Warner-Braztler shear force (P > 0.05). Sensory evaluation indicated that on day 0, retail display the initial juiciness, sustained juiciness, tenderness 1st impression, tenderness overall impression, and connective tissue in AHT steaks was not different from CON steaks (P > 0.05). A day effect (decrease) for those sensory parameters was observed only for sustained juiciness (P < 0.05). AHT steaks were rated higher in cooked beef flavor while CON steaks were higher in peppery and salty flavor. There was no difference in soapy and ammonia intensity between treatments. Results indicated that despite lower performance in cook loss the replacement of 4.5% sodium-based phosphate in a meat injection brine with 1% ammonium hydroxide produced a beef loin steak with comparable tenderness and palatability. Practical Application: The research in this study compares steaks that have been injected with a commercial brine formulated with sodium phosphates to steaks that have been injected with a brine where the sodium phosphate in the formulation was replaced with 1% ammonium hydroxide. Ammonium hydroxide is an USDA-FSIS approved ingredient in brines injected into fresh meats. Successful replacement of sodium phosphate with ammonium hydroxide would allow processors to significantly reduce the sodium content of injected fresh meat.

Purpose: To assess in vitro myocilin (MYOC) expression in trabecular meshwork (TM) cells exposed to BOL-303242-X, a selective glucocorticoid receptor (GR) agonist (SEGRA), in comparison with dexamethasone (DEX), and prednisolone acetate (PA)., Methods: After drug treatment of monkey TM cultures, MYOC protein in conditioned media (CM) was measured by Western blot and densitometry. MYOC mRNA levels were analyzed by qRT-PCR. RU-486 was tested for antagonism of MYOC protein expression induced by DEX and BOL-303242-X., Results: Baseline MYOC protein released into CM and MYOC mRNA were detected. DEX or PA elicited dose-dependent increases in MYOC in CM and also in MYOC mRNA. BOL-303242-X effects typified partial agonism, with significantly reduced MYOC protein and mRNA, compared with DEX. Maximum efficacy for BOL-303242-X was 53% of that for DEX. Mean EC(50) across all strains tested was lower, but not significantly different, for BOL-303242-X versus DEX. Compared with DEX, MYOC mRNA levels were significantly lower in BOL-303242-X-treated TM cells at the highest doses tested. EC(50)s for PA were higher than DEX, for both myocilin protein and mRNA. RU-486 displayed a dose-dependent antagonism to drug-induced increases in myocilin levels., Conclusions: In vitro quantitative assays of myocilin expression in TM cells can be used for characterizing anti-inflammatory drugs that are GR ligands. The results suggest that, compared with traditional ocular steroids, therapeutic doses of BOL-303242-X elicit a reduced myocilin expression profile in TM cells by virtue of the partial agonist properties of this compound.

The purpose of this study was to judge the feasibility of gasification for the disposal of waste streams generated through salmon harvesting. Gasification is the process of converting carbonaceous materials into combustible "syngas" in a high temperature (above 700 degrees C), oxygen deficient environment. Syngas can be combusted to generate power, which recycles energy from waste products. At 66% to 79% moisture, raw salmon waste streams are too wet to undergo pyrolysis and combustion. Ground raw or de-oiled salmon whole fish, heads, viscera, or frames were therefore "dried" by mixing with wood pellets to a final moisture content of 20%. Ground whole salmon with moisture reduced to 12% moisture was gasified without a drying agent. Gasification tests were performed in a small-scale, fixed-bed, updraft gasifer. After an initial start-up period, the gasifier was loaded with 1.5 kg of biomass. Temperature was recorded at 6 points in the gasifier. Syngas was collected during the short steady-state period during each gasifier run and analyzed. Percentages of each type of gas in the syngas were used to calculate syngas heating value. High heating value (HHV) ranged from 1.45 to 1.98 MJ/kg. Bomb calorimetry determined maximum heating value for the salmon by-products. Comparing heating values shows the efficiency of gasification. Cold gas efficiencies of 13.6% to 26% were obtained from the various samples gasified. Though research of gasification as a means of salmon waste disposal and energy production is ongoing, it can be concluded that pre-dried salmon or relatively low moisture content mixtures of waste with wood are gasifiable.

Paired USDA Select beef strip loins (n = 10), aged 2 d, were injected with either an alkaline-based (3.6% sodium chloride, 1% Herbalox seasoning, adjusted to pH 10 with ammonium hydroxide [approximately 0.1%, FFC grade]) or a phosphate-based (3.6% sodium chloride, 1% Herbalox seasoning, 4.5% sodium tripolyphosphate) brine. Steaks were evaluated for 19 d. Overall, phosphate-injected steaks performed better than alkaline-injected steaks with respect to cook yield, water holding capacity, lipid oxidation, color stability, tenderness, and juiciness. Phosphate-injected steaks also had less purge than alkaline-injected steaks, as confirmed by composition analysis. Phosphate-injected steaks were higher in moisture and ash content, and were nearly 2% lower in protein content. Alkaline-injected steaks had significantly lower aerobic (approximately 1 log lower) and anaerobic (approximately 2 log lower) plate counts. Final meat pH probably contributed to the differences observed between treatments. The final pH of phosphate-injected steak was 5.99 while that of alkaline-injected steak was 5.73. Further research should be conducted to determine the concentration of ammonium hydroxide needed in the alkaline-based brine to increase the final meat pH to similar levels found in the phosphate-injected steaks.

Catfish fillets were minced and acid (pH 3.0) solubilized in dilute conditions (1:9). Insolubles were removed by centrifugal force (3000 xg) and the soluble protein was recovered by isoelectric precipitation (pI approximately 5.4). Moisture and NaCl of the batters were equilibrated to 78% and 2%, respectively. Samples were stuffed into casings, cooked, and chilled. Proximate composition, color, cook yield, water holding ability (WHA), and texture profile analysis (TPA) were determined. Treatment of catfish protein by the solubilization process removed 74% of the fat. In addition, gels from treated protein were less red (-1.61 compared with -1.06) and yellow (6.58 compared with 7.09). There was no difference in whiteness (72.0 compared with 71.8) of gels or in percent cook yield (94.6% compared with 95.0%) between treated protein and the control, respectively. The WHA of gels made from control protein was 0.73 g/g protein higher than treated. The texture analysis indicated that treated proteins had significantly higher hardness (1193 g compared with 1046 g), springiness (0.919 compared with 0.897), chewiness (0.701 compared with 0.584), and cohesiveness (0.637 mJ compared with 0.619 mJ). The resilience was equivalent for both treated and control gels. The results indicated the protein solubilization process produced a low fat protein product with good gel strength properties.

Previous research has demonstrated that vitamin E (tocopherol) applied to muscle foods using an oil carrier targets the neutral lipid fraction (NLF: triacylglycerols) instead of the polar lipid fraction (PLF: phospholipids) and therefore does not act as an effective antioxidant. This paper demonstrates that δ-tocopherol (TOH) applied using a polar carrier was effectively incorporated into the PLF of ground beef and reduced subsequent TBARs development. TOH was incorporated in the PLF at 2820±231μg TOH/g lipid and in the NLF at 167±66.2μg TOH/g lipid. Cooking ground beef (patties) did not result in loss of absolute amount of δ-tocopherol (5020±975μg vs. 6220±1510μg TOH, respectively). In addition, the development of thiobarbituric reactive substances (TBARs) in cooked product was significantly (p<0.05) lowered by TOH incorporation on days 2, 9, 15, and 22.

A relatively newer class of chemotherapy agents, known as the epidermal growth factor receptor inhibitors (EGF-RIs), is being used to treat advanced stages of solid tumors. Acneiform eruptions are a frequent adverse effect and one which has been associated with increased survival in some studies. We describe 3 patients who presented shortly after initiation of EGF-RI therapy. Characteristics included an absence of comedones, facial and truncal involvement, and a perifollicular lymphoneutrophilic infiltrate detected on biopsy. Lesion counts were reduced with topical adapalene and oral tetracyclines in two patients. Patient 3 had dramatic clearance with low-dose isotretinoin (20 mg daily) until completion of EGF-RI therapy. Acneiform eruptions are a common adverse reaction to EGF-RI therapy and can be treated with traditional acne therapy. This should not be considered a drug hypersensitivity eruption or allergy, and patients should continue therapy. For patients with severe eruptions, oral isotretinoin is a consideration.

Select grade strip loins (n = 10) were enhanced 10% with either a phosphate or an acid solubilized protein solution. Color score, aerobic plate count, lipid oxidation, purge loss, cook yield, Warner-Bratzler shear force, and sensory analysis were measured to characterize storage quality. The phosphate injection consisted of 4.5% phosphate, 3.6% sodium chloride, 90.9% water, and 1% Herbalox seasoning. Two solutions were prepared for the protein injection: one consisting of 1:9 protein to water and the other an aqueous solution of 1% Herbalox seasoning and 3.6% sodium chloride. Enhancement solutions were injected twice at 5% to create a 10% total injection. It was found that the protein-enhanced steaks were comparable to phosphate-enhanced steaks for percent discoloration and overall acceptability. The phosphate-enhanced steaks performed better than the protein-enhanced steaks for lean color, fat color, aerobic plate count, lipid oxidation, percent purge, cook yield, and Warner-Bratzler shear force. It should be noted that for protein-enhanced steaks, lean color and cook yield, although statistically different, did perform similar to phosphate-enhanced steaks.

Hyperimmunoglobulin E syndrome (HIES) is a rare immunodeficiency associated with elevated serum IgE levels, eczematous skin, recurrent cutaneous infections, and distinctive musculoskeletal features. We report two cases seen at our institution and review the current literature. Patient 1 was an 18-month-old African American boy with recurrent staphylococcal cold abscesses, pneumonia, and bacteremia. He had severely eczematous skin, ultimately complicated by eczema herpeticum. After treatment of systemic infections with culture-directed antibiotics, a brief course of cyclosporine, 5 mg/kg, improved the dermatitis and allowed transition to long-term therapy with oral trimethoprim-sulfamethoxazole. Patient 2 was a 15-year-old Caucasian boy with long-standing HIES. He has been maintained on a regimen of interferon gamma injections given 3 times weekly and monthly intravenous immunoglobulin since the age of 3 years, prophylactic antibiotics, and low-dose fluconazole. He has occasional episodes of cold abscesses and sinusitis, but has had excellent control since institution of this regimen and has not experienced any adverse effects.

This cross-sectional study assessed the relationship between the degree of optic nerve pallor (optic atrophy) and visual function. Using a set of "gold standard" stereoscopic slides, the severity of optic atrophy for 270 eyes, each having sustained a bout of optic neuropathy, was graded. Good visual acuity was found in 55/86 (64.0%) mild, 54/119 (45.4%) moderate, and 21/65 (32.3%) marked optic atrophy eyes. Good visual field was found in 6/28 (21.4%) mild, 4/43 (9.3%) moderate, and 2/28 (7.1%) marked optic atrophy eyes. Good color vision was found in 31/46 (67.4%) mild, 12/62 (19.4%) moderate, and 7/31 (22.6%) marked optic atrophy eyes. A significant rank correlation was observed between optic atrophy and visual acuity (P < 0.001; rs = 0.356), visual field (P < 0.001; rs = -0.398), and color vision (P < 0.001; rs = -0.492). As the graded severity of optic atrophy increases, the proportion of eyes with good visual function decreases. Visual field, rather than visual acuity or color vision, appears to be a better indicator of the severity of visual loss, when optic atrophy is present.

Recovery of bioactive compounds, such as proteolytic enzymes, from waste streams is a means to both recuperate value and reduce environmental pollution. Previously optimized lab-scale parameters for the recovery of a stable crude protease fraction from Pacific whiting (Merluccius productus) surimi wash water were tested using pilot plant equipment. Pretreatment of surimi wash water with 60 degrees C heat, acidification to pH 6, and centrifugation doubled ultrafiltration membrane flux and significantly improved protease purity by reducing a majority of the 35-205 kDa proteins. Concentrated crude protease obtained from wash water contained predominantly cathepsin L activity. Enzyme purity was increased about 100-fold, and yield was approximately 80%. Stability (frozen and freeze-dried protease) was maintained for 9 weeks at -80 degrees C. Freeze-dried preparations were also stable for 9 weeks at 4 and -15 degrees C. Successful application of pilot plant conditions allows for sufficient production of protease for further investigations into their applicability.