Legislative review and recommendations for improving sun protection in schools

BACKGROUND

Sun exposure in schools can account for a large portion of childhood sun exposure before the age of 20 years, yet legislation in the United States is lacking to properly protect children. Schools serve as a foundational resource to introduce and implement sun-safe practices in the youth population.

METHODS

Federal and state legislation relating to the access of sunscreen, sun-protective apparel, and shade was reviewed via the website LegiScan.com.

RESULTS

At the time of publication, only 25 states have legislation in place that addresses and allows sunscreen to be used in school, given its classification as an over-the-counter medication. No state has implemented legislation allowing sunglasses to be worn in school, and only two states have laws explicitly allowing hats and other sun-protective apparel at schools. In addition, the provision of shade is addressed in four states.

CONCLUSIONS

With a significant portion of sun exposure occurring at schools, state and federal legislation must address sun protection for students, opening the door for expanded access and additional research related to skin cancer prevention.

Neutrophil-predominant bullous pemphigoid induced by checkpoint inhibitors: A case series

Checkpoint inhibitors have been revolutionary in the treatment of metastatic melanoma, non-small-cell lung cancer, and renal cell carcinoma. By restricting negative feedback of T-cells, checkpoint inhibitors allow the immune system to identify and destroy malignant cells. This enhanced immune response is efficacious in the treatment of the aforementioned malignancies; however, it may lead to immune-related adverse events. Bullous pemphigoid (BP) is a well-documented cutaneous adverse reaction of checkpoint inhibitors, with a majority of cases reporting an eosinophil-predominant or mixed inflammatory infiltrate. We report two cases of neutrophil-predominant BP presenting in patients on checkpoint inhibitors.

Nonsyndromic Craniosynostosis and Deformational Head Shape Disorders

This article provides an overview of etiology, epidemiology, pathology, diagnosis, and treatment of nonsyndromic craniosynostosis, including sagittal, metopic, coronal, lambdoid, and complex synostosis. Detailed discussion is presented regarding indications for surgical intervention and management options, including frontoorbital advancement, cranial vault reconstruction, endoscopic strip craniectomy, spring-assisted strip craniectomy, and cranial vault distraction osteogenesis. Deformational plagiocephaly is also presented with treatment options including repositioning, physical therapy, and helmet therapy.

Mouse middle ear ion homeostasis channels and intercellular junctions

Hypothesis

The middle ear contains homeostatic mechanisms that control the movement of ions and fluids similar to those present in the inner ear, and are altered during inflammation.

Background

The normal middle ear cavity is fluid-free and air-filled to allow for effective sound transmission. Within the inner ear, the regulation of fluid and ion movement is essential for normal auditory and vestibular function. The same ion and fluid channels active in the inner ear may have similar roles with fluid regulation in the middle ear.

Methods

Middle and inner ears from BALB/c mice were processed for immunohistochemistry of 10 specific ion homeostasis factors to determine if similar transport and barrier mechanisms are present in the tympanic cavity. Examination also was made of BALB/c mice middle ears after transtympanic injection with heat-killed Haemophilus influenza to determine if these channels are impacted by inflammation.

Results

The most prominent ion channels in the middle ear included aquaporins 1, 4 and 5, claudin 3, ENaC and Na⁺,K⁺-ATPase. Moderate staining was found for GJB2, KCNJ10 and KCNQ1. The inflamed middle ear epithelium showed increased staining due to expected cellular hypertrophy. Localization of ion channels was preserved within the inflamed middle ear epithelium.

Conclusions

The middle ear epithelium is a dynamic environment with intrinsic mechanisms for the control of ion and water transport to keep the middle ear clear of fluids. Compromise of these processes during middle ear disease may underlie the accumulation of effusions and suggests they may be a therapeutic target for effusion control.

Does Cleft Palate Width Impact Success of Cleft Repair?

Objective: Compare surgical and speech outcomes between the double-opposing Z-plasty (Furlow) palatoplasty vs the 2-flap palatoplasty based on the width of the palatal cleft.

Method: A prospective study of 232 patients with cleft palate repair from April 1995 to March 2010 at a tertiary care institution. The cleft palate was measured (mm) and repaired with a Furlow or 2-flap palatoplasty. Outcome measurements include fistula rate and secondary velopharyngeal insufficiency (VPI) repair.

Results: Primary cleft palate repair was performed on 232 patients by Furlow palatoplasty (n = 96) or 2-flap palatoplasty (n = 136). Patients were subdivided into 4 groups based on width: Group A 1 to 5 mm (n = 57), Group B 6 to 10 mm (n = 38), Group C 11 to 15 mm (n = 72), Group D 16 to 30 mm (n = 4). Fistula rates increase as the width of the palatal cleft increases. Fistula rates are similar between the Furlow and the 2-flap palatoplasty for each palatal width, except for clefts greater than 16mm. Two-flap palatoplasty has a higher rate of velopharyngeal insufficiency for all groups of cleft patients.

Conclusion: At our institution the Furlow and 2-flap methods of palatoplasty have similar fistula rates for all cleft widths; however the Furlow method has decreased risk for subsequent velopharyngeal insufficiency compared with the 2-flap method. These data should encourage performance of the Furlow palatoplasty whenever feasible.

Development of a Resorbable Tricalcium Phosphate (TCP) Amine Antibiotic Composite

Calcium phosphate collagen composites are currently being used to rebuild bone. Commercial collagen preparations have been claimed to he hvpo-antigenic but none are non-antigenic. The collagen in calcium phosphate collagen composites is eventually degraded to its component amino acids. Two thirds of collagen consists of glvcine, hvdroxvproline, and proline. Since both tricalcium phosphate (TCP) and collagen are resorbable and both can he utilized to form bone, incorporation of amino acids into TCP-amino acid composites should nrovide the building blocks for formation of new bone. Stich composites should also be non-antigenic. Previous work conducted with composites of amino acids with aluminum calcium phosphorous oxide (ALCAP) ceramics, has shown that these composites can be uised to repair traumatized bone in rats. In our study, experiments conducted with TCP cysteine, Ivsine, or proline composites showed that the composites, after setting to hardness, degrade slowly and can he molded into different froms. Dissolution studies were conducted with composites of TCP with each of the above amino acids in Tris-MCl buffer (PH 7.4) at 37°C in vitro. Experiments conducted with antibiotics showed that antibiotics such as penicillin and ervthromvcin can be incorporated into the TCP amino acid composite. Subcutaneous implants of TCP amino acid composites in rats showed that most of the TCP-proline composite was degraded bv day 4, TCP-lvsine composite he day 7, and TCP-cysteine composite by day 21. Our results suggest that TCP amino acid composites are biocomnatible and can he used to repair experimentally traumatized bone.

TdTomato and EGFP identification in histological sections: insight and alternatives

Tandem dimer Tomato (tdTomato) provides a useful alternative to enhanced green fluorescent protein (eGFP) for performing simultaneous detection of fluorescent protein in histological sections together with fluorescence immunohistochemistry (IHC). eGFP has many properties that make it useful for cell labeling; however, during simultaneous fluorescence IHC, the usefulness of eGFP may be limited. This limitation results from a fixation step required to identify eGFP in histological tissue sections that can mask antibody epitopes and adversely affect staining intensity. An alternative fluorescent protein, tdTomato, may assist concurrent detection of fluorescent protein within tissue sections and fluorescence IHC, because detection of tdTomato does not require tissue fixation. Tissue sections were obtained from various organs of mice ubiquitously expressing eGFP or tdTomato that were either unfixed or fixed with 4% paraformaldehyde. These tissues later were combined with fluorescence IHC. Both eGFP and tdTomato displayed robust signals in fixed frozen sections. Only tdTomato fluorescence, however, was detected in unfixed frozen sections. Simultaneous detection of fluorescence IHC and fluorescent protein in histological sections was observed only in unfixed frozen tdTomato tissue. For this reason, tdTomato is a useful substitute for eGFP for cell labeling when simultaneous fluorescence IHC is required.

An empirical analysis of stressors for gay men and lesbians

This research describes the empirical classification of stressors for gay men and lesbians. Volunteer respondents were recruited through a free local gay and lesbian newspaper, through gay and lesbian student organizations nationwide, through gay and lesbian bookstores nationwide, and at a gay festival in St. Louis. Nine hundred seventy-nine (979) participants completed a 70-item measure with stressors that had been identified in previous qualitative research. Participants were asked to indicate the degree to which they had experienced stress associated with a variety of experiences. Participants also completed a measure of dysphoria (CES-D), responded about their degree of openness regarding sexual orientation, and provided information about their relationship status and involvement with gay groups and activities. Using confirmatory factor analysis, a six-factor model was predicted to account for the data. One-factor, six-factor, and ten-factor models were tested. The ten-factor model yielded the best fit with the data and accounted for 63.5% of the variance. The factor structure remained stable when gay men were compared to lesbians, when those endorsing a predominantly gay versus exclusively gay orientation were compared, and when those in a relationship were compared to those who were not in a relationship. Increased gay stress was associated with more dysphoria. Implications of these findings are discussed and directions for future research are considered.

Pre- and posthemodialysis measures of serum albumin levels

OBJECTIVE

To determine whether there was a difference between pre- and posthemodialysis serum albumin levels and, if so, whether that difference correlated with the amount of fluid removed during treatment.

DESIGN

This descriptive study used a comparative data analysis strategy.

SAMPLE/SETTING

287 paired measurements of pre- and post-hemodialysis serum albumin levels were collected from 46 patients in a midwestern hemodialysis center.

METHODS

Pre- and posthemodialysis serum albumin levels were obtained using the bromcresol green method.

RESULTS

The pretreatment mean for serum albumin levels was 3.875 gm/dL (SD .4) and the posttreatment mean was 4.273 gm/dL (SD .599), significant at p < 0.0001. The amount of fluid removed during treatment was strongly correlated with the difference between pre- and posttreatment albumin levels (R = .6149; p < 0.0001). When data were sub-divided into three groups according to the amount of fluid removed during treatment, the mean differences between pre- and post hemodialysis albumin were significant at p < 0.0001.

CONCLUSION

The strong correlation with fluid removed during hemodialysis suggests that fluid overload may be responsible for the significantly higher posttreatment albumin values in most patients.

A novel method for rapid isolation of plasmid DNA

A new disposable chromatographic column, pZ523, has been developed for separating plasmid DNA from bacterial chromosomal DNA. Use of pZ523 spun columns eliminates the need for ethidium bromide-cesium chloride density gradients which require long centrifugation times. pZ523 purified plasmids have been shown to be of purity suitable for restriction analysis, ligation, transfection of mammalian cells and transformation of bacteria. Unlike the traditional ultracentrifugation method, pZ523 offers an extremely rapid alternative method for purifying large amounts of plasmid DNA (2.5 mg to 4.5 mg) from cleared bacterial lysates in only 25 minutes.

Chromosomally mediated intrinsic resistance to penicillin of penicillinase producing strains of Neisseria gonorrhoeae isolated in Sydney: guide to treatment with Augmentin

Single dose Augmentin treatment fails to cure an appreciable proportion of patients infected with penicillinase producing Neisseria gonorrhoeae (PPNG) strains in parts of the world where high levels of chromosomally mediated intrinsic resistance are also present in gonococci. The levels of intrinsic resistance to penicillin of 31 PPNG strains isolated in Sydney were assessed by obtaining beta lactamase negative variants of these strains and measuring the minimum inhibitory concentration of penicillin by agar plate dilution techniques. The levels of intrinsic resistance found in these imported PPNG strains were higher than those recorded for local isolates of non-PPNG strains, which indicates that caution should be exercised in the use of single dose Augmentin treatment of infections with PPNG strains in Sydney.

The value of visual evoked potential as a screening test in neurofibromatosis

Pattern reversal visual evoked potential (VEP) test was performed in 30 asymptomatic patients with neurofibromatosis (NF). All patients had normal visual acuity, visual fields, and ophthalmoscopic examination results. Pattern reversal VEP was abnormal in eight patients (26%). Seven of these patients had computed tomographic scans with reformated orbital views. Orbital computed tomographic scans were abnormal in six patients and in each case showed enlargement of the optic nerve on the side of VEP abnormality. Our data indicate that pattern reversal VEP is a valuable screening test in asymptomatic patients with NF. Because of the high incidence of VEP abnormality in such patients, VEP abnormality must be interpreted cautiously when a patient with NF is suspected of having other diseases or disorders that potentially affect the visual pathways.

Association of HLA B8 with spontaneous resolution in sarcoidosis

HLA may influence the natural history of some diseases. HLA frequencies have been compared in 164 healthy control subjects, 50 patients with sarcoid lung fibrosis, and 37 patients with sarcoidosis that resolved spontaneously. B8 was increased significantly in the resolved group compared to both healthy control subjects (p less than 0.001) and the fibrotic group (p less than 0.01). The results support the findings of other investigators, and are consistent with the hypothesis that inherited host factors, perhaps related to immune response, influence the clinical expression of sarcoidosis.

Adjective correlates for women on the CPI scales: a replication

In a replication of a ten-year-old study by Gough, peer-rated adjectives from the Adjective Check List were correlated with scores on the 18 standard scales of the California Psychological Inventroy (CPI) for 95 college sorority members. For each scale, the ten most positively and negatively correlated adjectives were selected for comparison with Gough's results. The absolute magnitude of the correlations, the qualitative content of the adjectives, and the degree of correspondence with Gough's findings were used to assess the extent to which each CPI scale achieved its stated objective.

Induction of cytotoxic lymphocytes directed against public alloantigens

The response of H-2k lymphocytes to in vitro stimulation by H-2b and HI2d spleen cells has been monitored for the production of cytotoxic lymphocytes (CL). Using cells from H-2b strains CL which were capable of lysing both H-2b and H-2d target cells (TC) were generated. These results, together with competitive inhibitor studies of the cytotoxic activity against H-2d TC, demonstrated that T lymphocytes can respond to both public and private alloantigens of the H-2 complex. When H-2d cells were used for stimulation two of the three strains tested induced CL with cytotoxic activity towards both H-2d and H-2b TC. These observations indicate that the T cell response to alloantigen, leading to the production of cytotoxic lymphocytes, can be multicomponent like the established B cell response and can be expected to be subject to as much phenotypic variation. The full complexity may only be revealed by examing a number of combinations of stimulating strains, methods of stimulation and different kinds of target cells.

INTRA VITAM BONE MARROW PUNCTURE IN PERNICIOUS ANEMIA

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