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Squamous cell carcinoma in situ of the hand and nail is an infrequent tumor but represents the majority of hand and nail malignancies. While the conventional treatments of invasive nail unit squamous cell carcinoma include Mohs micrographic surgery, wide local excision, or distal digit amputation, no standardized management paradigm for in situ disease exists and the necessity of surgical options is debated. This review aims to discuss the most commonly reported treatment methods and critically assess relevant management considerations in order to facilitate appropriate treatment decisions for nail unit SCCis across dermatologic practice settings. Assessment of the current literature reveals insufficient evidence to determine a standardized treatment for nail unit squamous cell carcinoma in situ. Rather, management is greatly impacted by multiple factors including the presence of subungual involvement, surgical candidacy, importance of curative treatment, and patient preferences regarding cosmesis and function versus cure. When cure is desired, Mohs micrographic surgery is the treatment of choice in most cases. In the setting of desired curative intent, but poor surgical candidacy, radiotherapy may be effective and provide a reasonable chance of functional and cosmetic preservation. Other methods including photodynamic therapy, electrodesiccation and curettage, cryotherapy, and intralesional chemotherapeutics may be appropriate in specific circumstances, but are generally limited by lack of evidence or impracticalities. Lastly, observation with palliation may be appropriate when considering exceedingly rare disease-related mortality.

The objective of this study was to examine the effects of metritis and subclinical hypocalcemia on reduction of uterine size in dairy cows using ultrasonography and sonomicrometry. Four piezoelectric crystals were implanted via laparotomy into the myometrium of the pregnant uterine horn of 12 pluriparous Holstein Friesian cows 3 weeks before the calculated calving date. Sonometric measurements were conducted daily from 2 days before parturition (= Day 0) until Day 14 after calving and then every other day until Day 28. Distances between adjacent crystals were expressed in relation to reference values obtained before calving. The diameter of the formerly pregnant uterine horn was measured using transrectal B-Mode sonography starting on Day 10. Cows were retrospectively divided into the following groups: cows without metritis (M-; n = 7), cows with metritis (M+; n = 5), cows with normocalcemia (SH-; Ca > 2.0 mmol/l on Days 1 to 3; n = 5) and cows with subclinical hypocalcemia (SH+; Ca < 2.0 mmol/l in at least one sample between Days 1 and 3; n = 7). Metritis did not affect (P > 0.05) sonometric measurements, but the diameter of the formerly pregnant horn was larger (P ≤ 0.05) between Days 15 and 21 in M+ cows than in M‒ cows. Reduction in uterine length in hypocalcemic cows was delayed (P ≤ 0.05) between Days 8 and 21 compared with normocalcemic cows, but the uterine horn diameter was not related to calcium status. In conclusion, both diseases affected reduction of uterine size until Day 28. Cows with metritis had a larger uterine diameter, possibly attributable to accumulation of lochia, and cows with subclinical hypocalcemia had delayed reduction of uterine length, presumably related to reduction of myometrial contractility.

Background: Atopic dermatitis (AD) is a common skin disorder of increasing prevalence. Many ophthalmologic conditions are associated with AD, including cataract formation. Posterior and anterior subcapsular cataracts have been described in AD. Topical and systemic corticosteroids have been implicated in the development of cataracts. The precise pathogenic mechanisms and risk factors for development of atopic cataract are not clear., Observation: We report a case of cataract development in a child with severe AD and performed an extensive review of the dermatologic and ophthalmologic literature pertaining to AD and cataract formation. The incidence, demographics, pathogenesis, and characteristics of atopic cataracts are evaluated., Conclusions: Atopic dermatitis alone is a risk factor to develop both posterior and anterior subcapsular cataracts. There is a slightly increased probability of posterior subcapsular cataracts. However, anterior subcapsular cataracts are more specific to AD. A positive correlation was found between atopic cataract development and a decreased inducibility of superoxide dismutase. This suggests that atopic cataract development is correlated with oxidative damage of the lens and related to chronic inflammation.

Uniform lime incorporation into sewage sludge is critical for biosolid lime stabilization processes. There is no class B biosolids regulation for lime incorporation. The slurry method is currently used to evaluate the pH of limed biosolids, but this method homogenizes the biosolids and potentially masks poor lime mixing. In this study, a flat-surface pH electrode was used in bench-scale and full-scale experiments to measure the pH of lime-stabilized biosolids without creating slurries. The standard deviation of 15 pH measurements at different locations in a biosolid sample was used to assess mixing quality. The bench-scale experimental study showed that well-mixed limed biosolids had consistently high pHs (approximately 12) with low standard deviations (< 0.5 pH units), whereas poorly mixed biosolids had areas with low pH (< 10) and high standard deviations (> 2 pH units). Poorly mixed biosolids exhibited rapid and marked pH reduction, as well as offensive odor generation, whereas well-mixed biosolids resisted pH reduction and offensive odor generation. The full-scale study aimed at improving lime incorporation and biosolids quality confirmed the use of a flat surface pH electrode to capture low pH regions in biosolids that were masked by the current slurry method.

The HLA complex on chromosome 6, especially of the HLA class II genes, plays an important role in the pathogenesis of insulin-dependent diabetes mellitus (IDDM). Three solitary long terminal repeats (LTRs) have been described in the vicinity of HLA DQ, two of them modifying the genetic susceptibility to type 1 diabetes on high-risk HLA DQ haplotypes. Therefore, we have investigated the putative regulatory properties of these retroviral promoters in different cell lines, including a number of B- and T-lymphoblastoid cell lines bearing different DQ haplotypes, employing a transient reporter gene assay. The transcriptional activity of appropriate constructs harboring an LTR linked to the luciferase reporter gene revealed different expression patterns which varied considerably between the investigated cell lines. DQ-LTR3 showed clear activities, whereby the levels of luciferase gene expression were also increased approximately 200-fold in the teratocarcinoma cell line GH. For the different B- and T-cell lines, no significant activity was detected for any of the investigated LTRs. Furthermore, we have analyzed the effect of DQ-LTR13 on distinct DQB1 promoters and could show an increased activity of the DQB1*0302 promoter under the influence of DQ-LTR13. It varied from 1.5- to 6-fold in different cell lines depending on the transcriptional orientation and position of the LTR and was independent of DQ-LTR3. Moreover, the impact of the LTR was different for the DQB1*0201 promoter demonstrating a decreasing effect. These data indicate that a DQ-LTR13-mediated impact on the DQB1 promoter activity exists which differs clearly between selected promoters.

Isotretinoin (13-cis-retinoic acid) is a retinoid that has been used over the past 2 decades to treat a wide variety of dermatologic conditions, some with great success. Although it is beneficial in many skin conditions, the side effects and toxicities of oral retinoids require careful monitoring by experienced physicians. The clinical applications of oral retinoids continue to expand both within and beyond the field of dermatology.

Tyrosinase activity is a key determinant of melanin production in skin. Because retinoic acid regulates tyrosinase activity in melanoma cells, we analyzed modulation of pigmentation in vivo by retinoic acid. Black and white subjects were either not treated, or treated topically for 4 d under occlusion with vehicle, retinoic acid (0.1%), or the irritant sodium lauryl sulfate (2%). In untreated skin, tyrosinase activity and melanin content were significantly greater (2.3 times, and 3.2 times, respectively) in blacks versus whites. Four days of treatment with topical retinoic acid did not alter tyrosinase activity or melanin content in black skin. In contrast, retinoic acid treatment significantly induced (2.7 times, n = 8) tyrosinase activity, compared to vehicle treatment, in white skin. Melanin content, however, remained unchanged at 4 d. In separate experiments, tyrosinase activity in white subjects (n = 25) was increased 16% (p = 0.01) in sodium lauryl sulfate-treated skin, and 77% (p = 0.0005) in retinoic acid-treated skin, compared to vehicle-treated skin. The effect of retinoic acid on tyrosinase activity could be differentiated from non-specific irritation, because tyrosinase activity in retinoic acid-treated skin was significantly greater (52%, p = 0.004) than sodium lauryl sulfate-treated skin. Similar results were obtained with the dihydroxyphenylalanine reaction done on vehicle, sodium lauryl sulfate-, and retinoic acid-treated white skin. Northern analysis (n = 6) and semi-quantitative polymerase chain reaction (n = 6) demonstrated that retinoic acid treatment did not alter tyrosinase mRNA levels in white skin. Western analysis revealed that induction of tyrosinase activity by retinoic acid also was not associated with increased tyrosinase protein content (n = 9), indicating that regulation of tyrosinase activity by retinoic acid occurs through a post-translational mechanism. These data demonstrate that low tyrosinase activity in white skin in vivo is retinoic acid inducible and high tyrosinase activity in black skin in vivo is neither further induced nor reduced by retinoic acid.

A 45-year-old man presented with the sudden onset of diaphoresis, generalized weakness, and bilaterally achy arms. Physical examination revealed cyanosis of the head, neck, and upper chest with dyspnea and hypotension. He had distant heart sounds. An upright portable chest radiograph suggested widening of the mediastinum. A right arm venogram was consistent with extrinsic obstruction of the superior vena cava. A computed axial tomography scan demonstrated blood in the pericardium and indistinct widening of the pulmonary outflow tract. Autopsy revealed three tears of the pulmonary artery above the level of valve cusps, and thinning of the artery walls suggested cystic medial necrosis. These findings are suggestive of an acute spontaneous rupture of the pulmonary artery, possibly secondary to cystic medial necrosis.