Eccrine porocarcinoma of the head: An important differential diagnosis in the elderly patient

Background: Eccrine porocarcinoma is a rare malignant tumor of the sweat gland, characterized by a broad spectrum of clinicopathologic presentations. Surprisingly, unlike its benign counterpart eccrine poroma, eccrine porocarcinoma is seldom found in areas with a high density of eccrine sweat glands, like the palms or soles. Instead, eccrine porocarcinoma frequently occurs on the lower extremities, trunk and abdomen, but also on the head, resembling various other skin tumors, as illustrated in the patients described herein. Observations: We report 5 cases of eccrine porocarcinoma of the head. All patients were initially diagnosed as having epidermal or melanocytic skin tumors. Only after histopathologic examination were they classified as eccrine porocarcinoma, showing features of epithelial tumors with abortive ductal differentiation. Characteristic clinical, histopathologic and immunohistochemical findings of eccrine porocarcinomas are illustrated. Conclusion: Eccrine porocarcinomas are potentially fatal adnexal malignancies, in which extensive metastatic dissemination may occur. Porocarcinomas are commonly overlooked, or misinterpreted as squamous or basal cell carcinomas as well as other common malignant and even benign skin tumors. Knowledge of the clinical pattern and histologic findings, therefore, is crucial for an early therapeutic intervention, which can reduce the risk of tumor recurrence and serious complications. Copyright (c) 2008 S. Karger AG, Basel

Characterizing unforced multi-decadal variability of ENSO:a case study with the GFDL CM2.1 coupled GCM

Large multi-decadal fluctuations of El Niño-Southern Oscillation (ENSO) variability simulated in a 4000-year pre-industrial control run of GFDL CM2.1 have received considerable attention due to implications for constraining the causes of past and future changes in ENSO. We evaluated the mechanisms of this low-frequency ENSO modulation through analysis of the extreme epochs of CM2.1 as well as through the use of a linearized intermediate-complexity model of the tropical Pacific, which produces reasonable emulations of observed ENSO variability. We demonstrate that the low-frequency ENSO modulation can be represented by the simplest model of a linear, stationary process, even in the highly nonlinear CM2.1. These results indicate that CM2.1’s ENSO modulation is driven by transient processes that operate at interannual or shorter time scales. Nonlinearities and/or multiplicative noise in CM2.1 likely exaggerate the ENSO modulation by contributing to the overly active ENSO variability. In contrast, simulations with the linear model suggest that intrinsically-generated tropical Pacific decadal mean state changes do not contribute to the extreme-ENSO epochs in CM2.1. Rather, these decadal mean state changes actually serve to damp the intrinsically-generated ENSO modulation, primarily by stabilizing the ENSO mode during strong-ENSO epochs. Like most coupled General Circulation Models, CM2.1 suffers from large biases in its ENSO simulation, including ENSO variance that is nearly twice that seen in the last 50 years of observations. We find that CM2.1’s overly strong ENSO variance directly contributes to its strong multi-decadal modulation through broadening the distribution of epochal variance, which increases like the square of the long-term variance. These results suggest that the true spectrum of unforced ENSO modulation is likely substantially narrower than that in CM2.1. However, relative changes in ENSO modulation are similar between CM2.1, the linear model tuned to CM2.1, and the linear model tuned to observations, underscoring previous findings that relative changes in ENSO variance can robustly be compared across models and observations

Extensive Chaos in the Nikolaevskii Model

We carry out a systematic study of a novel type of chaos at onset ("soft-mode turbulence") based on numerical integration of the simplest one dimensional model. The chaos is characterized by a smooth interplay of different spatial scales, with defect generation being unimportant. The Lyapunov exponents are calculated for several system sizes for fixed values of the control parameter $\epsilon$. The Lyapunov dimension and the Kolmogorov-Sinai entropy are calculated and both shown to exhibit extensive and microextensive scaling. The distribution functional is shown to satisfy Gaussian statistics at small wavenumbers and small frequency.Comment: 4 pages (including 5 figures) LaTeX file. Submitted to Phys. Rev. Let

Parameter estimation in spatially extended systems: The Karhunen-Loeve and Galerkin multiple shooting approach

Parameter estimation for spatiotemporal dynamics for coupled map lattices and continuous time domain systems is shown using a combination of multiple shooting, Karhunen-Loeve decomposition and Galerkin's projection methodologies. The resulting advantages in estimating parameters have been studied and discussed for chaotic and turbulent dynamics using small amounts of data from subsystems, availability of only scalar and noisy time series data, effects of space-time parameter variations, and in the presence of multiple time-scales.Comment: 11 pages, 5 figures, 4 Tables Corresponding Author - V. Ravi Kumar, e-mail address: [email protected]

Finished genome of the fungal wheat pathogen Mycosphaerella graminicola Reveals dispensome structure, chromosome plasticity, and stealth pathogenesis.

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Poverty in the Social World of the Wise

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68560/2/10.1177_030908928701203704.pd

Measuring quality of life of people with predementia and dementia and their caregivers: a systematic review protocol

Introduction Dementia is the fastest growing major cause of disability globally and may have a profound impact on the health-related quality of life (HRQoL) of both the patient with dementia and those who care for them. This review aims to systematically identify and synthesise the measurements of HRQoL for people with, and their caregivers across the full spectrum of, dementia from its preceding stage of predementia to end of life. Methods and analysis A systematic literature review was conducted in Medical Literature Analysis and Retrieval System Online , ExcerptaMedicadataBASE, Cochrane Database of Systematic Reviews , Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effect, National Health Service Economic Evaluation Database and PsycINFO between January 1990 and the end of April 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. HRQoL measurements will be presented separately for people with dementia and caregivers by instrument used and, when possible, HRQoL will be reported by disease type and stage of the disease. Descriptive statistics of the results will be provided. A narrative synthesis of studies will also be provided discussing differences in HRQoL measurements by instrument used to estimate it, type of dementia and disease severity. Ethics and dissemination This systematic literature review is exempt from ethics approval because the work is carried out on published documents. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer’s disease spectrum for better care: multimodal data access platform (ROADMAP)

Treatment of eccrine porocarcinoma with metastasis to the parotid gland using intensity-modulated radiation therapy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cutaneous eccrine porocarcinomas are uncommon malignant tumors of the sweat gland.</p> <p>Case Presentation</p> <p>A 76-year-old Caucasian man presented to our hospital with a left temporal mass. We describe a case of eccrine porocarcinoma with metastasis to the parotid gland with special emphasis on the role of surgical resection and adjuvant radiation therapy.</p> <p>Conclusion</p> <p>Besides surgical resection, little is known about the role of adjuvant therapy in managing eccrine porocarcinomas. Radiation therapy should be considered within a multidisciplinary approach in patients with primary or recurrent eccrine porocarcinomas.</p