Grading differentiation in cutaneous squamous cell carcinoma: a review of the literature.

Poor differentiation is strongly associated with poor outcomes in cutaneous squamous cell carcinoma (CSCC). In addition, the National Comprehensive Cancer Network (NCCN) guidelines designate poorly differentiated tumors as "very high risk". Despite its clear prognostic implications, there is no standardized grading system for CSCC differentiation in common use today. CSCC differentiation is graded inconsistently by both dermatopathologists and Mohs surgeons, and reliability studies have demonstrated suboptimal inter- and intra-rater reliability in both of these groups. The absence of a standardized and reliable grading system has impeded the use of differentiation in CSCC staging, despite its apparent correlation with disease outcomes. We performed a comprehensive review of the literature summarizing historical CSCC differentiation grading systems, as well as grading systems in non-cutaneous head and neck SCC as a point of reference. Relevant articles were identified by searching Embase and PubMed, as well as by reviewing reference lists for additional articles and histology textbook excerpts. CSCC grading systems that were identified and summarized include the historical Broders system, the World Health Organization system, the College of American Pathologists' system, and a system described by a 2023 Delphi consensus panel of dermatopathologists.

Antistreptococcal treatment of psoriasis: a systematic review.

Streptococcal infections may contribute to psoriasis development, and antistreptococcal treatments are considered potential therapies, but their effectiveness remains uncertain due to limited systematic evidence. Our objective was to analyze antistreptococcal therapies' effectiveness in improving psoriasis. We conducted a systematic review following PRISMA guidelines, evaluating antistreptococcal treatment efficacy in psoriasis patients from PubMed, Scopus, and Embase databases until August 14, 2022. Eligible studies included psoriasis patients undergoing antistreptococcal therapy, regardless of demographics or psoriasis type. 50 studies (1778 patients) were analyzed, with penicillins/aminopenicillins as the most studied antibiotics (21 studies), showing mixed outcomes, some reporting significant improvement in guttate psoriasis, while others showed no significant difference. Rifampin demonstrated positive results in most of ten studies, and macrolides showed varying effectiveness in two studies. Tonsillectomy in 14 studies (409 patients) mainly focusing on guttate and chronic plaque psoriasis showed positive outcomes, indicating improved symptoms and quality of life. Limitations include heterogeneous studies, sampling bias, and quality of evidence. This systematic review reveals limited and varied evidence for systemic antibiotic therapy efficacy in psoriasis treatment, while tonsillectomy emerges as a potentially beneficial antistreptococcal option, urging further well-designed, controlled studies with larger sample sizes and standardized protocols for better comparisons.

Cutaneous Squamous Cell Carcinoma Outcomes in Solid Organ Transplant Recipients: A Matched Retrospective Cohort Study.

BACKGROUND: Solid organ transplant recipients with cutaneous squamous cell carcinoma (CSCC) have an increased risk of poor outcomes. However, a recent study demonstrated that immunosuppression is not an independent risk factor for these poor outcomes after controlling for primary tumor stage. OBJECTIVE: To evaluate whether transplant status is an independent risk factor for poor outcomes in CSCC. MATERIALS AND METHODS: A database of CSCCs treated at an academic center over 10 years was used to perform a retrospective cohort study comparing the risk of poor outcomes (local recurrence, regional and distant metastases, and disease-specific death) in solid organ transplant recipients and controls. Subjects were matched on age, tumor stage, sex, tumor site, and time to poor outcome. RESULTS: There were 316 tumors from 78 transplant patients and 316 tumors from 262 controls. On multivariate analysis, tumor stage and location on the head and neck were predictive of poor outcomes. There was no significant difference in the risk of poor outcomes in the transplant group versus the control group. CONCLUSION: Transplant status was not an independent risk factor for poor squamous cell carcinoma outcomes after controlling for stage, age, sex, site, and time to poor outcome.

The role of sentinel lymph node biopsy in extramammary paget disease: a systematic review.

Sentinel lymph node biopsy is increasingly used to detect subclinical nodal metastases in extramammary Paget disease. We performed a comprehensive systematic review of the literature to further explore the role of sentinel lymph node biopsy in extramammary Paget disease. Five databases were searched for relevant terms. Articles were included if they were in English and presented primary data on at least one patient with extramammary Paget disease who underwent sentinel lymph node biopsy in the absence of lymphadenopathy or known metastatic disease. Twenty-eight articles were included, with 366 subjects. Seventy-seven sentinel node biopsies (21.2%) were positive, including 12 in which the primary tumor had microinvasion (15.6%) and 56 with deep invasion (72.7%). Of the positive cases, 11 (14.3%) had no further treatment, 54 (70.1%) underwent nodal dissection, 4 (5.2%) were treated with systemic agents, and 1 (1.3%) had radiation. After a mean follow up of 24 months, 9 subjects with a positive lymph node biopsy experienced nodal recurrence (11.7%), 15 had distant metastases (19.5%), and 13 died of the disease (16.9%). In conclusion, invasive extramammary Paget disease is strongly associated with poor outcomes including nodal metastasis, distant metastasis, and disease specific death. Sentinel lymph node biopsy is a useful tool to screen for subclinical nodal metastases in invasive disease, and can be used to help guide clinical management.

Factitial dermatitis in the hospital setting.

Factitial Dermatitis (FD) is a notoriously difficult disease to diagnose, as patients produce self-induced cutaneous lesions and provide an inadequate or inaccurate history. We performed a cross-sectional study, querying an inpatient consultation database of all patients admitted to the Ohio State University Wexner Medical Center from 2012 to 2017 with a dermatologic ICD as a discharge diagnosis. Our exhaustive keyword search produced 189 candidates. Consult notes were thoroughly examined, and 32 patients were found to meet case definition of FD. Our analysis of this cohort revealed a significantly greater proportion of cases in the female population. Lesions were more often found to involve the skin on the upper extremities. Isolated secondary skin changes such as erosions, ulcers and excoriations in the absence primary morphologies were also significant in our cohort. As FD is difficult to identify, further understanding of its presentation pattern will decrease time to diagnosis and improve both hospital resource allocation and patient care.

Evaluation of Dundee and ALT-70 predictive models for cellulitis in 56 patients who underwent tissue culture.

Nonpurulent cellulitis lacks a gold standard to distinguish noninfectious sources of inflammation. Two models have been created that evaluate cellulitis. The ALT-70 model was created to reduce the overdiagnosis of cellulitis and provide clinical direction. The Dundee classification was developed to grade the severity of previously diagnosed cases of cellulitis and enhance treatment and clinical outcomes. We analyzed a dataset of 56 patients who were admitted to the OSU Wexner Medical Center with a primary admission diagnosis of cellulitis. Each patient underwent extensive tissue culture sampling to identify potential pathogens. Patients were scored using both models, then evaluated based on the positive tissue culture and skin and soft tissue infection. In both models, we found low sensitivity and specificity to predict patients with positive tissue culture cellulitis. Determination of a gold standard for classification of cellulites is important to improve future diagnosis and risk models. We recommend further study to develop a scalable consensus standard in the diagnosis of nonpurulent cellulitis.

Patient Care Outcomes in Hospitalized Patients with Acute Generalized Exanthematous Pustulosis: A Cross-Sectional Database Study.

BACKGROUND: Current understanding of the etiology, natural history, and outcomes of acute generalized exanthematous pustulosis (AGEP) has been limited, with most available studies consisting of small or heterogenous cohorts. OBJECTIVES: The aim of this study was to further characterize associated factors and disease outcomes of AGEP. METHODS: A cross-sectional study design was employed with formal inclusion and causality criteria. Patients were identified from an inpatient database at an academic medical center, including 65 patients with AGEP and a control group of 61 patients with non-severe cutaneous adverse reactions. RESULTS: Increased age and body mass index (BMI) were associated with higher risk of AGEP (p < 0.001). Length of stay was longer for both the overall AGEP cohort (13.1 days) and a subcohort with a primary discharge diagnosis of AGEP (9.7 days) compared with the control group (3.6 days) [p < 0.001]. Patients with AGEP were more likely to be discharged to a long-term care facility compared with control patients (p < 0.001). CONCLUSIONS: AGEP was associated with longer length of hospitalization, higher rates of discharge to long-term care facilities, and higher mortality compared with non-severe cutaneous adverse drug reaction (SCAR) medication reactions. Future research should examine the association between morbid obesity and this particular drug reaction, and the possibility of decreasing hospitalization length given the relatively low risk of mortality among patients with AGEP.

Clinical and immunologic differences in cellulitis vs. pseudocellulitis.

Introduction: The immunologic mechanisms between cellulitis and pseudocellulitis differ greatly, even though their clinical presentations may overlap.Areas covered: This article discusses cellulitis and common entities within the pseudocellulitis spectrum including acute lymphedema, superficial venous thrombosis, allergic contact dermatitis, lipodermatosclerosis, stasis dermatitis, erythema nodosum, cutaneous gout, and bursitis. The literature search was conducted from PubMed search engine between March and May 2021.Expert commentary: While immunologic differences in cellulitis and the various entities of pseudocellulitis are clear, there is a practice gap in applying these differences to the clinic and hospital setting. Further, existing studies are weakened by the lack of a gold-standard diagnosis in this disease category. Additional work is necessary in developing a gold-standard for the diagnosis and secondly, to project these immunologic differences as biomarkers to differentiate sterile inflammation from a potential life threatening bacterial or fungal infection.

Combating Vaccine Hesitancy with Vaccine-Preventable Disease Familiarization: An Interview and Curriculum Intervention for College Students.

In 2019, the World Health Organization (WHO) listed vaccine hesitancy in its top ten threats to global health. Vaccine hesitancy is a "delay in acceptance or refusal to vaccinate despite availability of vaccination services". Urban areas with large amounts of vaccine hesitancy are at risk for the resurgence of vaccine-preventable diseases (VPDs). Many vaccine-hesitant (VH) parents may be unfamiliar with the consequences of VPDs, and thus might be swayed when confronted with the symptoms and dangers of VPDs. As such, we sought to educate college students (future parents) in an urban vaccine-hesitant hotspot by assigning them to interview family or community members who had experienced a VPD. Student vaccine attitudes were assessed by surveys before and after the interviews. Vaccine-hesitant students who conducted a VPD interview but received no additional vaccine educational materials were significantly more likely (interaction term p < 0.001) to become pro-vaccine (PV) (68%) than students who conducted an autoimmune interview and received no additional educational materials. Additionally, students whose interviewees experienced intense physical suffering or physical limitations or students who were enrolled in a course with intensive VPD and vaccine curriculum had significantly increased vaccine attitudes. This suggests that introducing students to VPDs can decrease vaccine hesitancy.

Emotions are understood from biological motion across remote cultures.

Patterns of bodily movement can be used to signal a wide variety of information, including emotional states. Are these signals reliant on culturally learned cues or are they intelligible across individuals lacking exposure to a common culture? To find out, we traveled to a remote Kreung village in Ratanakiri, Cambodia. First, we recorded Kreung portrayals of 5 emotions through bodily movement. These videos were later shown to American participants, who matched the videos with appropriate emotional labels with above chance accuracy (Study 1). The Kreung also viewed Western point-light displays of emotions. After each display, they were asked to either freely describe what was being expressed (Study 2) or choose from 5 predetermined response options (Study 3). Across these studies, Kreung participants recognized Western point-light displays of anger, fear, happiness, sadness, and pride with above chance accuracy. Kreung raters were not above chance in deciphering an American point-light display depicting love, suggesting that recognizing love may rely, at least in part, on culturally specific cues or modalities other than bodily movement. In addition, multidimensional scaling of the patterns of nonverbal behavior associated with each emotion in each culture suggested that similar patterns of nonverbal behavior are used to convey the same emotions across cultures. The considerable cross-cultural intelligibility observed across these studies suggests that the communication of emotion through movement is largely shaped by aspects of physiology and the environment shared by all humans, irrespective of differences in cultural context. (PsycINFO Database Record

Surface water and the origin of the positive excess specific heat for 7 nm rutile and anatase nanoparticles.

Specific heats (15-350 K) have been measured on 7 nm TiO2 anatase and rutile nanoparticles containing significant amounts of surface-adsorbed water. By successively reducing the water content without changing particle size, we observed two types of water behavior. The specific heat of bare 7 nm particles was estimated using the water specific heats. Contrary to previous literature reports, the bare small particle specific heats are the same as those of the bulk, within experimental error.