BRAFV600E Mutation Status of Involuting and Stable Nevi in Dabrafenib Therapy with or without Trametinib

IMPORTANCE Recent advances in targeting BRAF(V600E) mutations, which occur in roughly 50% of melanomas and 70% of benign nevi, have improved response rates and survival in patients with melanoma. With increased survival, the importance of other comorbidities increases and requires consideration in long-term management. This case report discusses dynamic dermoscopic nevus changes that occur during dabrafenib therapy and offers some conclusions regarding BRAF mutations and the changes

FIGO best practice guidance in surgical consent

Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure-specific checklists for the most common obstetric and gynecological procedures

Fin-Tail Coordination during Escape and Predatory Behavior in Larval Zebrafish

Larval zebrafish innately perform a suite of behaviors that are tightly linked to their evolutionary past, notably escape from threatening stimuli and pursuit and capture of prey. These behaviors have been carefully examined in the past, but mostly with regard to the movements of the trunk and tail of the larvae. Here, we employ kinematics analyses to describe the movements of the pectoral fins during escape and predatory behavior. In accord with previous studies, we find roles for the pectoral fins in slow swimming and immediately after striking prey. We find novel roles for the pectoral fins in long-latency, but not in short-latency C-bends. We also observe fin movements that occur during orienting J-turns and S-starts that drive high-velocity predatory strikes. Finally, we find that the use of pectoral fins following a predatory strike is scaled to the velocity of the strike, supporting a role for the fins in braking. The implications of these results for central control of coordinated movements are discussed, and we hope that these results will provide baselines for future analyses of cross-body coordination using mutants, morphants, and transgenic approaches

Quantifying the orientation of acquired Melanocytic nevi on the back

Acquired melanocytic nevi are a well-known risk factor in the development of melanoma; their increased frequency is associated with increased risk. Many recent studies have focused on the dermoscopic diagnosis of melanoma in addition to investigation of nevogenesis.1,2 However, the clinical appearance of nevus orientation has not been a target of investigation. Although not aiming to identify new phenomena, we attempt herein to quantify and explain the orientation patterns of acquired melanocytic nevi on the back. Blaschko lines are a well-described pattern of skin lines that correlates with epidermal nevi and may relate to acquired melanocytic nevus orientation.3 Quatresooz et al,4 while investigating lines of tension in skin on the back, identified a dermoscopic parallel melanotic line pattern on the normal skin of the back aligned with skin tension lines called Langer lines.4 We propose that a pattern of acquired melanocytic nevus orientation is identifiable and may be associated with both Blaschko and Langer lines

Overall structure of larval startle.

<p>The bearing (0° at t = 0), tail bend angle, and pectoral fin extensions are shown for the entirety of a response to a startling auditory stimulus (Panel A). Individual frames from the behavior are shown in Panels B–I), with accompanying timestamps. The approximate time for each of these frames is indicated by an arrow in Panel A. This startle event is composed of three phases, a rapid high-amplitude bend of the tail (C-bend), a strong counter bend and tail beat (fast swim), and then a slower, less dramatic alternating tail beat accompanied by pectoral fin extensions (slow swim). Scale bar in B represents 1 mm. The larva shown is 7 dpf.</p

Pectoral fin movements in prey tracking.

<p>Panel A shows the kinematics of a larva swimming toward a paramecium. The forward swim takes the form of shallow, roughly symmetrical tail bends, with extension of the outside pectoral fin. This results in alternating extensions of the fins. The distance to the paramecium decreases as a result of this maneuver. A J-turn is represented in Panel B. The tail bends in a single direction (left, or negative, in this case), and the pectoral fins beat in unison. The bearing to the prey drops, but the distance to the prey remains unchanged. There is a strong relationship between the degree of the tail bend and the size of the bearing change (Panel C, p<0.001 (unpaired t-test with Welch's correction), linear regression R² = 0.78), while the activities of the fins have no direct effect on the magnitude of the turn (Panel D, p>0.05 in all cases, unpaired t-test with Welch's correction).</p

Method of kinematic analysis.

<p>Panel A shows a single frame from a high-speed movie of a 14 dpf larva that is pursuing a prey item, in this case a paramecium. In panel B, ten landmarks have been manually placed on the larva and prey. Panel C shows the resulting point-and-line representation of the larva and prey, with numbers automatically assigned to each point. The XY coordinates of each point are shown in panel D, along with automatically extracted information on the larva's fins, tail, and position relative to the paramecium. Panel E shows a portion of the overall pursuit and capture event, indicating the tail bend, extension of each fin, and distance and bearing to the paramecium through time. The arrow indicates the frame represented in panels A–D. Scale bar in A represents 1 mm.</p

Pectoral fin abduction scales with strike velocity.

<p>Panels A, B and C show the movements of the tail and both pectoral fins for strikes of increasing velocity. The velocity of the larva is shown in blue. The moment of capture (t = 0) is indicated by a vertical dotted line. Panel D shows the correlation that exists between strike velocity and the total fin adduction that occurs following the strike (n = 8; unpaired t-test with Welch's correction, p<0.001; linear regression, R² = 0.70). The events shown in panels A, B, and C are indicated.</p

Components of prey capture.

<p>The chart in panel A shows a larva's pursuit and capture of a paramecium (arrow, B). The individual elements of the behavior are indicated by red lines. Panels B–I show individual frames from the movie of this sequence, with approximate times of the frames indicated by arrows in Panel A. The paramecium is indicated with an arrow in panel B, and all panels show the same field of view. Panels B and C show opposite tail bends of a forward swim, with extensions of the outside pectoral fin in each case. The larva pauses in panel D. Panel E shows the unilateral tail bend typical of a J-turn, with the outside pectoral fin extended. An S-bend is seen in panel F, which leads to the capture of the paramecium in panel G. Strong abductions of both pectoral fins are seen immediately after capture (Panel H), before the larva turns and swims away (Panel I). Time stamps are shown for each panel. The scale bar in B represents 1 mm. The larva shown is 7 dpf.</p