Comparison of ex vivo and in vivo dermoscopy in dermatopathologic evaluation of skin tumors

IMPORTANCE: Ex vivo dermoscopy (EVD) can be a valuable tool in routine diagnostic dermatopathologic evaluation. OBJECTIVES: To compare in vivo dermoscopy (IVD) and EVD and to provide guidance for routine dermatopathologic evaluations. DESIGN, SETTING, AND PARTICIPANTS: This observational study collected 101 consecutive IVD and EVD images of skin tumors from a private dermatology practice from March 1 to September 30, 2013. Four observers (3 dermatologists and 1 dermatopathologist) blinded to the histopathologic diagnoses independently scored and compared the colors, structures, and vessels of EVD images with those of the corresponding IVD images. Data were analyzed from January 1 to March 31, 2014. MAIN OUTCOMES AND MEASURES: Concordance between the EVD and IVD images and gain or loss of colors, structures, and vessels on EVD relative to IVD images. RESULTS: The final analysis included 404 observations of 101 images. The EVD image was generally similar to the corresponding IVD image but clearly darker, with new areas of blue in 130 of 404 observations (32.2%) and white in 100 of 404 observations (24.8%) and loss of red in 283 of 404 observations (70.0%). Most structures were well preserved. New structureless areas were found in 78 of 404 observations of EVD images (19.3%), and new crystalline structures were detected in 68 of 404 observations of EVD images (16.8%). On EVD images, squames and crusts were lost in 56 of 404 observations (13.9%) and 43 of 404 observations (10.6%), respectively. Blood vessels were lost in 142 of 404 observations of EVD images (35.1%). CONCLUSIONS AND RELEVANCE: The EVD image is an important new tool in dermatopathology and may give direction to targeted tissue processing and examination of skin tumors

Histopathological cutaneous alterations in systemic sclerosis: a clinicopathological study

Introduction: The aims of the present study were to identify histopathological parameters which are linked to local clinical skin disease at two distinct anatomical sites in systemic sclerosis (SSc) patients with skin involvement (limited cutaneous systemic sclerosis (lcSSc) or diffuse cutaneous systemic sclerosis (dcSSc)) and to determine the sensitivity of SSc specific histological alterations, focusing on SSc patients without clinical skin involvement (limited SSc (lSSc)). Methods: Histopathological alterations were systematically scored in skin biopsies of 53 consecutive SSc patients (dorsal forearm and upper inner arm) and 18 controls (upper inner arm). Clinical skin involvement was evaluated using the modified Rodnan skin score. In patients with lcSSc or dcSSc, associations of histopathological parameters with local clinical skin involvement were determined by generalised estimation equation modelling. Results: The hyalinised collagen score, the myofibroblast score, the mean epidermal thickness, the mononuclear cellular infiltration and the frequency of focal exocytosis differed significantly between biopsies with and without local clinical skin involvement. Except for mononuclear cellular infiltration, all of the continuous parameters correlated with the local clinical skin score at the dorsal forearm. Parakeratosis, myofibroblasts and intima proliferation were present in a minority of the SSc biopsies, but not in controls. No differences were found between lSSc and controls. Conclusions: Several histopathological parameters are linked to local clinical skin disease. SSc-specific histological alterations have a low diagnostic sensitivity

Clinical significance of the expression of c-Ski and SnoN, possible mediators in TGF-beta resistance, in primary cutaneous melanoma

Background: Loss of TGF-beta growth control is Considered as a hallmark of several human neoplasms including melanoma. Resistance of cancer cells to TGF-beta has been linked to mutations in proteins involved in the TGF-beta pathway. In melanoma such mutations have not been observed. C-Ski and SnoN, two structurally and functionally highly homologous proteins, are known as negative regulators in the TGF-beta signaling pathway. C-Ski and SnoN expression levels and subcellular localization have been associated with clinicopathological parameters and turnout Progression in several human malignancies. In melanoma cell lines, high c-Ski and SnoN expression levels have been described. Objective: The objective of this study was to evaluate the clinical value of c-Ski and SnoN expression in primary Cutaneous melanoma. Methods: We evaluated c-Ski and SnoN expression by immunohistochemical staining in 120 primary melanomas. Possible associations between c-Ski and SnoN staining patterns and clinicopathological parameters were analyzed. Results: Nuclear c-Ski expression was significantly associated with thicker and ulcerated tumours. The percentage of SnoN positivity was higher in ulcerated tumours and in the sentinel node positive group. Conclusion: These results suggest that c-Ski and SnoN, mediators in TGF-beta resistance, might be implicated in melanoma growth and progression. (c) 2008 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved

Aptitude-based assignment of nurses to depressed patients

The study investigated the relationships between psychiatric nurse aptitudes and outcomes of depressive patients in residential psychiatric care. Upon admission, it is common practise for one nurse to be assigned to a patient for the entire hospital stay. Nurses differ individually. Depending on their professional rank (novice, proficient, master), nurses rely on other components of aptitude to care for their patients. Depending on a nurse's professional rank, other relationships exists between specific nurse aptitudes and certain changes in a patient's depressive feelings. Novice nurses should be assigned to patients that suffer more from performance impairment than negative attitudes towards self, whereas master nurses should be assigned to patients that suffer more from negative attitudes towards self than performance impairment. As a patient recovers, depressive feelings can change (e.g. switching from performance impairment to negative attitudes towards self). Our results suggest that nursing assignments should change in line with the dominant type of dysfunction displayed by the patient. This recommendation differs with current practises of assigning the same nurse to a patient for the entire hospital stay. Abstract In psychiatric units, head nurses face the daily challenge of assigning nurses to patients. The match between a patient and a nurse is not always optimal. This can hinder the therapeutic relationship. Aptitude is an important component of competence, especially for psychiatric nurses involved in therapeutic relationships. In this study, we undertook explorative research to investigate possible relationships between nurse aptitudes and outcomes in depressed patients. We found statistically significant relationships between specific nurse aptitudes, along professional rank, and particular patient outcomes. During the hospital stay, patients' depressive feelings change as they recover. Our results indicate that, as a patient's depressive feelings change, another type of nurse, one with an aptitude that supports the patient's current needs, should be assigned to care for that patient. This suggestion is at odds with current practises of assigning a patient to one nurse for the entire hospital stay

Validation of a new concept: aptitudes of psychiatric nurses caring for depressed patients

Validation is vital for operationalising a new concept into a measurement instrument. The measurement of human attributes is usually done with questionnaire items in ordered categories. Our objective was to validate a questionnaire capable of measuring, at the ordinal level, the aptitude of psychiatric nurses caring for depressed patients. We used expert panels, experimentation, categorical principal component analysis, and parametric and non-parametric item response theory to develop such a questionnaire and assess its validity. Expert panels delineated five aspects and 29 components of aptitude and formulated 32 items. Four consecutive exploratory experiments were performed to gauge and calibrate the items and their response categories into a semantic frame of reference and a socio-cultural and job context of nurses. This resulted in a questionnaire comprising three aspects of aptitude. Fourteen questionnaire items with a different number of response categories assessed aptitude. Appropriate techniques shed light onto how nurses understand and respond to items in the questionnaire. Before it can be reliably used in a different context, the questionnaire needs to be re-evaluated for validity. Moreover, validity needs to be re-established for translated versions. In conclusion, validation is a process. Understanding that the scope and limitations of a questionnaire develop as it is being used requires validity to be re-established at each step of development