Validation of epidermal AMBRA1 and loricrin (AMBLor) as a prognostic biomarker for nonulcerated American Joint Committee on Cancer stage I/II cutaneous melanoma

BACKGROUND

Combined expression of the autophagy-regulatory protein AMBRA1 (activating molecule in Beclin1-regulated autophagy) and the terminal differentiation marker loricrin in the peritumoral epidermis of stage I melanomas can identify tumour subsets at low risk of -metastasis.

OBJECTIVES

To validate the combined expression of peritumoral AMBRA1 and loricrin (AMBLor) as a prognostic biomarker able to identify both stage I and II melanomas at low risk of tumour recurrence.

METHODS

Automated immunohistochemistry was used to analyse peritumoral AMBRA1 and loricrin expression in geographically distinct discovery (n = 540) and validation (n = 300) cohorts of nonulcerated American Joint Committee on Cancer (AJCC) stage I and II melanomas. AMBLor status was correlated with clinical outcomes in the discovery and validation cohorts separately and combined.

RESULTS

Analysis of AMBLor in the discovery cohort revealed a recurrence-free survival (RFS) rate of 95.5% in the AMBLor low-risk group vs. 81.7% in the AMBLor at-risk group (multivariate log-rank, P < 0.001) and a negative predictive value (NPV) of 96.0%. In the validation cohort, AMBLor analysis revealed a RFS rate of 97.6% in the AMBLor low-risk group vs. 78.3% in the at-risk group (multivariate log-rank, P < 0.001) and a NPV of 97.6%. In a multivariate model considering AMBLor, Breslow thickness, age and sex, analysis of the combined discovery and validation cohorts showed that the estimated effect of AMBLor was statistically significant, with a hazard ratio of 3.469 (95% confidence interval 1.403-8.580, P = 0.007) and an overall NPV of 96.5%.

CONCLUSIONS

These data provide further evidence validating AMBLor as a prognostic biomarker to identify nonulcerated AJCC stage I and II melanoma tumours at low risk of disease recurrence.

The influence of magnetic order on the magnetoresistance anisotropy of Fe1 + δ-x Cu x Te

We performed resistance measurements on [Formula: see text]Cu _x Te with [Formula: see text] in the presence of in-plane applied magnetic fields, revealing a resistance anisotropy that can be induced at a temperature far below the structural and magnetic zero-field transition temperatures. The observed resistance anisotropy strongly depends on the field orientation with respect to the crystallographic axes, as well as on the field-cooling history. Our results imply a correlation between the observed features and the low-temperature magnetic order. Hysteresis in the angle-dependence indicates a strong pinning of the magnetic order within a temperature range that varies with the Cu content. The resistance anisotropy vanishes at different temperatures depending on whether an external magnetic field or a remnant field is present: the closing temperature is higher in the presence of an external field. For [Formula: see text] the resistance anisotropy closes above the structural transition, at the same temperature at which the zero-field short-range magnetic order disappears and the sample becomes paramagnetic. Thus we suggest that under an external magnetic field the resistance anisotropy mirrors the magnetic order parameter. We discuss similarities to nematic order observed in other iron pnictide materials.

Mohs micrographic surgery and secondary intention healing of a plantar melanoma in-situ

This report details an acral melanoma in-situ on theright plantar foot that was successfully treated withMohs micrographic surgery and secondary intentionwound healing.

Microvessel density, lymphovascular density, and lymphovascular invasion in primary cutaneous melanoma-correlation with histopathologic prognosticators and BRAF status

The relationship between microvessel density (MVD), lymphovascular density (LVD), and lymphovascular invasion (LVI) in primary cutaneous melanoma (PCM) remains unclear. Given this, a total of 102 PCMs were assessed for MVD (vascular endothelial growth factor receptor 2 and Endocan), LVD (D2-40), and LVI (immunostaining with D2-40/S-100 and hematoxylin and eosin); tumoral S-100A13, vascular endothelial growth factor receptor 2, and Endocan; and BRAF status. LVD was associated with MVD (P = .01). MVD was higher in PCMs with depth greater than or equal to 2 mm and ulceration (P = .04, .05), whereas LVD was higher in PCMs with depth greater than or equal to 2 mm and mitoses (P = .03, .02). After adjusting for MVD and LVD, only ulceration was associated with LVI (P < .02). A BRAF mutation was seen in 30.4% cases, and when present, both LVD and host response (P = .0008 and .04, respectively) were significantly associated with MVD. Immunostaining with S-100A13 was noted in 99% of cases and a significant association noted only with ulceration (P = .05). Immunostaining increased LVI positivity (46.5% versus 4.9% by hematoxylin and eosin, P < .0001). MVD and LVD are not associated with LVI, appear to be closely related with each other, and are associated with select markers of poor prognosticative value. The association between a host response and LVD and MVD in PCMs with a BRAF mutation suggests that they exhibit potential for strategizing immunotherapies.

Magnetic breakdown in the electron-doped cuprate superconductor Nd(2-x)Ce(x)CuO4: the reconstructed Fermi surface survives in the strongly overdoped regime

We report on semiclassical angle-dependent magnetoresistance oscillations and the Shubnikov-de Haas effect in the electron-overdoped cuprate superconductor Nd(2-x)CexCuO4. Our data provide convincing evidence for magnetic breakdown in the system. This shows that a reconstructed multiply connected Fermi surface persists, at least at strong magnetic fields, up to the highest doping level of the superconducting regime.

Correlating array comparative genomic hybridization findings with histology and outcome in spitzoid melanocytic neoplasms

Melanocytic neoplasms with spitzoid features including spitz nevi, spitz tumors and spitzoid melanomas are commonly encountered in the practice of dermatopathology. Although many cases can be accurately diagnosed on the basis of morphology and histology, a significant number of cases may be difficult to accurately classify. Several studies have now shown that chromosomal copy number aberrations are typical of melanoma while present in only a small percent and to a limited degree in spitz nevi. In this study, we correlated the clinical, histologic and array CGH findings of 10 spiztoid melanocytic neoplasms. Our study shows that the clinical and histologic changes correlate well with the molecular findings by array CGH. Further that array CGH can be used to help classify and predict behavior of spitzoid melanocytic neoplasms. A limited variety of copy number aberrations including gains of 11p and much more rarely 7q may be seen in spitz nevi. Additionally in this report we present the first case of a typical spitz nevus with copy number gains involving both 7q and 11p. Conversely, melanomas with spitzoid features typically have multiple chromsomal copy number aberrations involving a variety of loci. A smaller number of chromosomal aberrations, possibly a single aberrant locus, may be present in spitz tumors, but their presence may predict more aggressive behavior.

Evolution of the Fermi surface of the electron-doped high-temperature superconductor Nd(2-x)Ce(x)CuO(4) revealed by Shubnikov-de Haas oscillations

We report on the direct probing of the Fermi surface in the bulk of the electron-doped superconductor Nd(2-x)Ce(x)CuO(4) at different doping levels by means of magnetoresistance quantum oscillations. Our data reveal a sharp qualitative change in the Fermi surface topology, due to translational symmetry breaking in the electronic system which occurs at a critical doping level significantly exceeding the optimal doping. This result implies that the (pi/a, pi/a) ordering, known to exist at low doping levels, survives up to the overdoped superconducting regime.

The vanishing biopsy: the trend toward smaller specimens

Dermatopathologists have noted an increased number of smaller biopsy specimens. Our objective was to determine whether dermatologists are changing their choice of biopsy technique and the size of biopsy specimens. We conducted a retrospective study of 500 biopsies performed by dermatologists for the purpose of diagnosis in 1988, 1993, 1998, and 2003. Our study results indicate that dermatologists are performing fewer punch biopsies and more shave biopsies. What's more, there has been a decrease in the size of shave biopsy specimens. We believe that the decreased number of punch biopsies being performed combined with the decreased size of shave biopsy specimens may affect patient care.

Basic immunology: a primer

This article is intended to bring practicing physicians up to date on the current state of knowledge regarding the basic components and processes of the immune system. It discusses the role of the immune system and the importance of self-tolerance and describes the main cellular and noncellular entities involved in the immune response. It also details immune processes such as the lymphocyte selection process leading to self tolerance; antigen processing and presentation; cell signaling, activation, and co-stimulation; and the actions of cytokines and other signaling molecules.

Successful treatment of extramammary Paget's disease with imiquimod

Extramammary Paget's Disease (EMPD) is an uncommon neoplasm found in the genital, anorectal, or axillary area. Surgical excision is considered the standard treatment, although possible loss of tissue function and disease recurrence are seen. Other treatment modalities such as radiotherapy, topical chemotherapy, and photodynamic therapy are associated with varying degrees of effectiveness, but the search for an effective, safe treatment with minimal side effects proves to be challenging. We report a case where complete clinical and histological resolution of non-invasive EMPD of the penis was achieved with minimal adverse effects after six weeks of imiquimod (Aldara) application. As an immune system modifier that stimulates cytokine and interferon production, imiquimod may be a useful alternative or adjuvant in the treatment of EMPD.

Evaluation of chronic urticaria in patients with Hashimoto thyroiditis

The coincidence of Hashimoto thyroiditis (HT) and chronic idiopathic urticaria (CIU) is a commonly observed phenomenon in western New York. Previous literature suggested that there may be a direct relationship between them. We undertook these studies to determine whether humoral or cell-mediated mechanisms might link HT and CIU. Skin biopsies from patients with CIU, with or without HT, were indistinguishable by light microscopy. No immune complex deposition was observed, although only the skin from patients with CIU and HT contained perivascular fibrin deposits. Similarly, immunohistochemical studies evaluating cellular expression of CD3, CD4, CD8, CD20, and CD68 failed to differentiate between CIU with or without HT. Analysis of Vbeta restriction in thyroid tissue of patients with HT and the skin of patients with CIU and HT by in situ polymerase chain reaction failed to reveal any oligoclonal T-lymphocyte subpopulations. In contrast, only patients with CIU and HT had anti-FcepsilonRI antibodies in their sera that could induce degranulation of normal basophils. Some sera from patients with CIU and HT caused degranulation of normal basophils in the absence of anti-FceRI. The factor causing basophil degranulation in these sera was not determined. Patients with CIU and HT failed to improve clinically with thyroid replacement therapy. All CIU patients were equally well managed with symptomatic therapies. In conclusion, HT likely represents a marker of other autoimmunity, rather than being a direct causative agent in CIU. Management of CIU, with or without HT and with or without anti-FceRI antibodies, should be the same. Future studies will have to examine whether cell-mediated responses participate in CIU, especially in association with HT.

Striate palmoplantar keratoderma: a clinical and ultrastructural study

Palmoplantar keratodermas are poorly understood heterogeneous disorders of cornification. Autosomal dominant and autosomal recessive keratodermas with a varied clinical presentation are recognized. Striate keratoderma is uncommon. We report the case of a 15-year-old girl with keratoderma that began at 5 months of age. Her clinical and ultrastructural findings are reviewed. Routine microscopic examination revealed eosinophilic inclusions in the granular cell layer as well as prominence of the granular cell layer. Electron microscopic examination revealed corneocytes with an imbricated pattern. Ultrastructural findings in this unique case are contrasted with those of other palmoplantar keratodermas.

The effect of hand therapy on a patient with a colles' fracture:

The purpose of this phenomenological study was to gain an understanding of the effect of disability, specifically a Colles' fracture, and the role of occupational therapy in the recovery of function. On three separate occasions, a person with a Colles' fracture was interviewed on videotape. Data from the interviews were transcribed and the emergent concepts were organized into themes. One theme, ''just the everyday things'' illustrates the participant's frustration with her disability and another, ''standard program,'' addresses the hand therapist's reliance on a canned program. Themes from the study are discussed in terms of the consumer's experience of dysfunction and receiving occupational therapy services.

Palisading cutaneous fibrous histiocytoma. An immunohistochemical study demonstrating differentiation from dermal dendrocytes

The palisading cutaneous fibrous histiocytoma is a unique benign spindle cell tumor that often occurs in an acral location. Histologic findings feature nuclear palisading reminiscent of a schwannoma. Previous studies have suggested that this tumor may be a variant of a dermatofibroma. We performed immunohistochemical staining with a panel of antibodies including neurofilament, S100 protein, factor XIIIa, epithelial membrane antigen, Leu-7, desmin, and vimentin. We found positive staining with factor XIIIa and vimentin, suggesting connective tissue differentiation for this tumor.

Fixed drug eruption from pamabrom

A young woman presented with recurrent skin lesions that were predominantly perioral. Fixed drug reaction was diagnosed based on her history of intermittent ingestion of Pamprin, a common menstrual symptom reliever, and characteristic erythematous, pigmented, edematous patches. After oral challenge with two of the three ingredients in Pamprin, a diagnosis of fixed drug reaction to pamabrom was made. Pamabrom is a mild diuretic present in several over-the-counter and prescription menstrual symptom relievers. This is the first reported case of fixed drug reaction to pamabrom.

Correlation between caries experience in primary and permanent dentition in birth-cohorts 1950-70

Caries experience in the primary molars and canines at 8 yr of age and in the permanent dentition at 16 was correlated in every fourth birth-cohort between 1950 and 1970 in a Danish community. Correlations between 0.44 and 0.55 were found. Cross-tabulation of the data also revealed close association, but prediction of individual high caries risk children based solely on screening for caries experience in the primary dentition is hardly cost-effective.

Caries among Danish schoolchildren in birth-cohorts 1950-78

Data on caries prevalence are reported from 8- and 16-yr-old children living in a Danish community which established the Public Child Dental Health Service in 1957. Every fourth birth-cohort from 1950 through 1970 was followed longitudinally. In the 8-yr-olds, caries prevalence decreased in the primary dentition from 17 to 3 dmfs and in the permanent dentition from 3.4 to 0.3 DMFS over a 28-yr period. Among the 16-yr-olds, a reduction was observed from 16.4 to 5.1 DMFS over 20 yr. Time trends in the decreasing caries prevalence are related to various organizational events and preventive measures. Moreover, the possible influence of general changes in living conditions and health behavior is pointed out.

Contact urticaria and anaphylaxis to latex

Contact urticaria and anaphylaxis to latex is reported in two patients. One case was associated with oral and vaginal exposure to a condom and the other with rectal exposure to a latex glove. Both patients had positive reactions to scratch or prick tests to pieces of latex, as well as latex radioallergosorbent test (RAST). The diagnosis of contact urticaria to latex is difficult to make on the basis of history alone.

[Association among general health, diet and need of dental care among retired pensioners living at home]

A pilot project was established in a Danish municipality with the aim of improving the nutrition of 67-85-year-olds living at home but who were dependent on domestic aid for purchasing or preparing their food. The project comprised health education and information concerning dietary habits as well as an offer of dental treatment to those who were physically or mentally handicapped. At initiation of the project, the persons (n = 110; 89% of the target population) were interviewed about their general and dental health, ailments, drug consumption, and diet. Furthermore, a clinical dental examination was made (n = 106). From these baseline registrations, the elderly were divided into subgroups: unbalanced, moderate, and balanced diet; low, moderate, and high consumption of, respectively, water/milk and coffee/tea; great, moderate, and no need for dental care. Systematic associations were found between general health problems and unbalanced diet. A tendency was observed toward more frequent complaints in the groups with relatively high consumption of water/milk and water/milk/coffee/tea. The strongest associations were found between general health complaints, handicaps, and masticatory deficiency on the one hand and great need for dental care on the other. Also, the group with great need for dental care was overrepresented in the group with unbalanced diet. It is argued that accessibility to dental care would improve the chances for the elderly to stay in their own homes.

Changes in prevalence of approximal caries in 17-year-olds and related restorative treatment strategies over a 6-year period

Two cohorts of 17-yr-olds treated in a municipal child dental service in 1978-79 and 1984-85 had bitewing radiographs taken at the examination before the last course of treatment in the service. All radiographs were read by one examiner, who did not know to which cohort the individual belonged. The subsequent treatment was recorded from the treatment records by another examiner, who was unaware of the results of the radiographic examination. According to radiographic scores, the proportion of decayed or filled (DFS) approximal surfaces had decreased from 23.2% to 17.4% during the period (difference: 25%). The proportion of unfilled surfaces which were decayed (DS) had remained almost constant, while 9.6% of the surfaces were filled (FS) in 1978-79 compared to 3.1% in 1984-85 (difference: 68%). Thus, in spite of a 25% decrease in total caries experience (DFS), a reduction of 68% would be claimed if fillings (FS) were interpreted as expression of disease prevalence. The risk of an approximal surface being filled decreased to about one fifth from 1978-79 to 1984-85, and the risk of being filled was nearly three times as high for approximal surfaces of children who already had approximal fillings at the time of examination. Thus, both the year of examination and the subject's previously received treatment seemed to influence the treatment strategy of the dentist.