Nodular Melanoma in an African American Female.

Melanoma incidence is increasing and is associated with the majority of skin cancer-related deaths. Most melanomas have an indolent growth and are difficult to diagnose, attributing to their increased risk of metastatic disease on initial presentation. Nodular melanoma accounts for roughly 15% to 30% of all the melanomas, making it the second most common melanoma. This case describes nodular melanoma, the atypical presentation, the diagnosis, and the treatment. This case is of special interest due to the rarity of the disease and this particular patient's disease presentation and management. Unfortunately, the patient refused further surgery, so definitive treatment was not achieved.

Fat Grafting and Adipose-Derived Regenerative Cells in Burn Wound Healing and Scarring: A Systematic Review of the Literature.

BACKGROUND: There is an abundance of literature supporting the efficacy of fat grafting in aesthetic and reconstructive cases. There has been a recent emphasis on the regenerative capacity of adipose-derived stem cells and their utility in the improvement of wound healing and scarring provided by their cytokine and growth factor profiles. Despite the wealth of evidence supporting their efficacy, little attention has been paid to their utility in burn treatment. The authors' purpose was to provide an analysis of the literature regarding the use of fat grafting and regenerative cells in the treatment of burn wounds to guide surgeons and scientists on their clinical use. METHODS: A systematic review of the literature was performed by a thorough search of 12 terms using the PubMed, Medline, and Cochrane databases. Two hundred forty-one articles were subject to evaluation by predetermined inclusion and exclusion criteria. RESULTS: Six murine and 12 human studies were selected, including case-control studies, case series, and case reports. They describe histologic and clinical effects of fat grafting and regenerative cell therapy, including improvements in burn scar size and texture, enhanced angiogenesis, decreased inflammation, alleviation of pain, and return of function. CONCLUSIONS: There is a dearth of randomized controlled trials and quantitative analysis supporting the efficacy of fat grafting and adipose regenerative cells in burns. However, the subjective improvements in scars are encouraging. The authors hope that this review will be a foundation for future studies and will highlight the breadth of knowledge yet to be explored by this therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Further phenotypic and genetic variation in ADULT syndrome.

ADULT (Acro-dermato-ungual-lacrimal-tooth) syndrome is characterized by ectrodactyly, syndactyly, fingernail and toenail dysplasia, hypoplasia of the breast and nipple, excessive freckling, lacrimal duct atresia, frontal alopecia, primary hypodontia, and/or early loss of permanent teeth. It is a rare autosomal dominant disorder which has been linked to mutation in the p63 gene. The p63 gene has been described in five overlapping limb malformation syndromes including the EEC syndrome (ectodermal ectrodactyly clefting). We report on the first case of ADULT syndrome of a mother and daughter with a new mutation R227Q in exon 6 of the p63 gene. This has not been previously associated with ADULT syndrome but only seen in EEC. In addition to the previously reported features of ADULT syndrome this report also describes some additional findings including hyperextensibility at the distal interphalageal joints, bilateral thumb duplication, bifid toenails, symptoms of urinary retention, vesicoureteric reflux, prominent ears, conductive hearing loss, and an overgrowth of a patch of hair in the midline of the neck. This report expands the knowledge of genotype-phenotype data on the p63 gene and suggests there may be a considerable overlap between the EEC syndrome and the ADULT syndrome.

Passage in monolayer influences the response of chondrocytes to dynamic compression.

This study tests the hypothesis that expansion by passage in monolayer influences the response of isolated articular chondrocytes to dynamic compression. Chondrocytes, isolated from bovine articular cartilage, were seeded in monolayer and passaged 4 times (P1-4). For assessment of chondrocytic and fibroblastic phenotype, freshly isolated and passaged cells were seeded on glass coverslips or in 2% alginate beads and cultured for 7 days in DMEM + 10% FCS. Samples were assayed for DNA and GAG content and stained for collagen types I and II. In separate experiments, freshly isolated or passaged chondrocytes were seeded at 10 x 10(6) cells.ml(-1) in 4% cylindrical agarose constructs and subjected to 15% dynamic compressive strain at 1 Hz for 24 hours. [(3)H]-thymidine incorporation, SO(4) incorporation and nitrite release were analysed. Immediately following isolation (P0), chondrocytes seeded in alginate expressed high levels of type II collagen, but did not stain for type I collagen. Following repeat passage the cells expressed enhanced levels of type I collagen, with an associated reduction in type II collagen staining. These data indicate a modulation to a fibroblastic phenotype during monolayer expansion which was not rapidly reversed by culture in a 3D hydrogel. Dynamic compression down-regulated SO(4) incorporation at P0, but did not affect [(3)H]-thymidine incorporation. By contrast the incorporation of both SO(4) and [(3)H]-thymidine was enhanced by dynamic compression at both P1 and to a lesser extent P2. SO(4) and [(3)H]-thymidine incorporation were inhibited at P3 and P4. Nitrite release was down-regulated by dynamic compression at all passages. These data demonstrate a clear modulation in the response of bovine articular chondrocytes to dynamic compression following passage in monolayer.

Expansion of chondrocytes for tissue engineering in alginate beads enhances chondrocytic phenotype compared to conventional monolayer techniques.

Chondrocytes are known to dedifferentiate when cultured in monolayer culture, which may compromise the efficacy of cartilage repair systems in which cells are expanded by repeat passage in monolayer prior to implantation. We tested the hypothesis that repeat passage in alginate beads can provide sufficient expansion of cells, while producing cells with enhanced chondrocytic phenotype. Bovine articular chondrocytes were seeded in 2% alginate beads or in monolayer. 4 passages at 7-day intervals were performed. Values of 9.1 days for monolayer expansion and 12.5 days for alginate expansion were estimated for a 10-fold increase in cell number. For assessment of chondrocytic and fibroblastic phenotype, expanded cells were seeded in alginate beads or on glass coverslips and cultured for 7 days. On subsequent seeding in alginate, cells which had previously been subcultured in alginate showed higher levels of both DNA and GAG synthesis than cells passaged in monolayer. Furthermore, the alginate-passaged cells retained a chondrocytic phenotype, indicated by synthesis of type II collagen and chondroitin-6-sulphate, while cells passaged inmonolayer synthesised type I collagen, indicating a fibroblastic phenotype. In conclusion, expansion of cells for autologous cartilage repair systems, using subculture within alginate beads, provides a potentially attractive alternative to monolayer expansion.