Abstract
Basal cell carcinoma is the most frequent malignant tumor of the skin, and the most common carcinoma found in some countries. The main clinical subtypes of BCC are nodular, superficial, pigmented and morpheaform. The majority of the lesions appear on the head and neck, with a particular predilection on the upper central part of the face. Here we report a 62 year-old woman with two different morphological types of BCC which developed in the same area. The tumors have developed two months apart on the right paranasal region in close proximity. With the clinical examination and histopathological examination of punch biopsy specimens, the diagnoses of the lesions were confirmed as a nodular and an adenoid BCC. The tumors were totally removed with surgical excision. Neither recurrence nor new lesion was observed on the lesional or near areas in a 24-month follow-up period. To the best of our knowledge the presence of the two different morphological types of BCC in the same anatomical location has not been reported previously.
Cutaneous squamous cell carcinoma (SCC) is the second most common cancer in the United States, and high-risk SCC is associated with more aggressive tumor behavior and correlated with poorer outcomes. This case study illustrates a patient who was found to have a large, fungating mass that had been neglected for 20 years. An excisional biopsy was completed, and the mass was identified histologically with two distinct patterns of invasive carcinoma: SCC and adenoid basal cell carcinoma, thus a collision tumor. This case report discusses risk factors and possible treatment options for this rare presentation.
Desmoplastic Non-Infantile Ganglioglioma; An Incidental Finding with Unusual ...CrimsonPublishersTNN
Desmoplastic non-infantile ganglioglioma (DNIG) is a rare tumor entity and only a small number of cases have been published until now in the literature. Although its infantile counterpart (desmoplastic infantile ganglioglioma [DIG]) has been already recognized and included together with desmoplastic infantile astrocytoma (DIA) in the WHO Classification of CNS tumors, DNIG has not been accepted as a distinct tumor entity. The reason for this is obviously the scarcity of the neoplasm and subsequently the absence of substantial information regarding its pathogenesis and its association to the infantile form.
Cutaneous squamous cell carcinoma (SCC) is the second most common cancer in the United States, and high-risk SCC is associated with more aggressive tumor behavior and correlated with poorer outcomes. This case study illustrates a patient who was found to have a large, fungating mass that had been neglected for 20 years. An excisional biopsy was completed, and the mass was identified histologically with two distinct patterns of invasive carcinoma: SCC and adenoid basal cell carcinoma, thus a collision tumor. This case report discusses risk factors and possible treatment options for this rare presentation.
Desmoplastic Non-Infantile Ganglioglioma; An Incidental Finding with Unusual ...CrimsonPublishersTNN
Desmoplastic non-infantile ganglioglioma (DNIG) is a rare tumor entity and only a small number of cases have been published until now in the literature. Although its infantile counterpart (desmoplastic infantile ganglioglioma [DIG]) has been already recognized and included together with desmoplastic infantile astrocytoma (DIA) in the WHO Classification of CNS tumors, DNIG has not been accepted as a distinct tumor entity. The reason for this is obviously the scarcity of the neoplasm and subsequently the absence of substantial information regarding its pathogenesis and its association to the infantile form.
Neuroblastomas are rare extracranial tumors of the pediatric population arising from cells of the embryological sympathetic nervous system. These malignancies most commonly occur in the abdomen, but other sites include the chest, neck, and pelvis with a predisposition for lymphatic and hematogenous
spread. Metastasis to the bone is a poor prognostic indicator, requiring surgical excision and other extensive medical management.
Malignant melanoma is one of the most aggressive neoplasms of the skin. It originates from the melanocytes, which are cells derived embryologically from the neural crest and migrate to the epidermal basal layer. It is characterized by producing pigmentation as well as being susceptible to metastasis. We report the case of a 36-year-old female patient with advanced clinical stage and distant commitment. The biopsy confirmed the presence of Grade III invasive nodular cutaneous melanoma in the left subscapular region with lymph node metastasis with reactive hyperplasia. An exploratory research is carried out with the bibliographic review in scientific journals with evidence level II–IV. In portals PubMed, Redalyc, BVS, and UpToDate. 81241 met criteria 2248 of which 629 were chosen for having access to the full text and of these 496 are more current (as of 2008), and in the end, 27 articles were selected that met all the inclusion criteria to this article. Due to the increase in the incidence of this disease in recent years and its poor prognosis in short to medium term, it is important to know and follow-up on patients with known risk factors for this disease such as the presence of previous nevi, with emphasis on measures of prevention.
Metastatic Atypical Fibroxanthoma: Case Report of an Uncommon Pathology in the Head and Neck by Luis Boccalatte in Experiments in Rhinology & Otolaryngology
Atypical fibroxanthoma (AFX) is an uncommon skin neoplasm developed mainly in the head and neck region in older senior patients. Prolonged sun exposure, actinic damaged, history of previous neoplasms and immunosuppressant are considered the most important risks factors. Subcutaneous extension of these tumors is related to a more aggressive biology.
https://crimsonpublishers.com/ero/fulltext/ERO.000521.php
O.O.Bogomolets National Medical University's AchivementMevar Nirav
An Indian Student of final year of MBBS in O.O.Bogomolets National Medical University has researched clinical case presentation of craniofacial meningioma with associated acromegaly, diabetes mellitus type-2 labyrinthine tumour. This research is a very big achievement in Ukraine.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Neuroblastomas are rare extracranial tumors of the pediatric population arising from cells of the embryological sympathetic nervous system. These malignancies most commonly occur in the abdomen, but other sites include the chest, neck, and pelvis with a predisposition for lymphatic and hematogenous
spread. Metastasis to the bone is a poor prognostic indicator, requiring surgical excision and other extensive medical management.
Malignant melanoma is one of the most aggressive neoplasms of the skin. It originates from the melanocytes, which are cells derived embryologically from the neural crest and migrate to the epidermal basal layer. It is characterized by producing pigmentation as well as being susceptible to metastasis. We report the case of a 36-year-old female patient with advanced clinical stage and distant commitment. The biopsy confirmed the presence of Grade III invasive nodular cutaneous melanoma in the left subscapular region with lymph node metastasis with reactive hyperplasia. An exploratory research is carried out with the bibliographic review in scientific journals with evidence level II–IV. In portals PubMed, Redalyc, BVS, and UpToDate. 81241 met criteria 2248 of which 629 were chosen for having access to the full text and of these 496 are more current (as of 2008), and in the end, 27 articles were selected that met all the inclusion criteria to this article. Due to the increase in the incidence of this disease in recent years and its poor prognosis in short to medium term, it is important to know and follow-up on patients with known risk factors for this disease such as the presence of previous nevi, with emphasis on measures of prevention.
Metastatic Atypical Fibroxanthoma: Case Report of an Uncommon Pathology in the Head and Neck by Luis Boccalatte in Experiments in Rhinology & Otolaryngology
Atypical fibroxanthoma (AFX) is an uncommon skin neoplasm developed mainly in the head and neck region in older senior patients. Prolonged sun exposure, actinic damaged, history of previous neoplasms and immunosuppressant are considered the most important risks factors. Subcutaneous extension of these tumors is related to a more aggressive biology.
https://crimsonpublishers.com/ero/fulltext/ERO.000521.php
O.O.Bogomolets National Medical University's AchivementMevar Nirav
An Indian Student of final year of MBBS in O.O.Bogomolets National Medical University has researched clinical case presentation of craniofacial meningioma with associated acromegaly, diabetes mellitus type-2 labyrinthine tumour. This research is a very big achievement in Ukraine.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Abstract
A new method for improvement of 1,2-indandione-treated latent fingermarks on thermal paper will be described in this paper. Treatment with conventional techniques like ninhydrin in petroleum ether or DFO solution produces a black color on the thermosensitive side of thermal paper. The new method using 5,6-dimethoxy-1,2-indandione with polyvinyl pyrrolidone (PVP) can reduce this dark staining without removing the thermosensitive layer and parts of the developed fingermarks. An advantage of this method is that the developed fluorescent fingermarks appear in sharp lines and high contrast . The developed fingermarks can be observed when excited in the 535 nm region and using an orange-red goggles. There is no background coloration in this method. In addition, some tests were performed, leading to an optimized working solution, which charges the paper with a minimum of chemicals, is cheap, and enables a large quantity of papers to be treated in a short time and without involving any pre- or post treatment.
JOURNAL OF VETERINARY SCIENCE & ANIMAL HUSBANDRYAnnex Publishers
Journal of Veterinary Science and Animal Husbandry (JVSAH) is a scientific journal which has topics associated with fundamental and aspects of veterinary science and animal husbandry. JVSAH has a special feature of publishing special issues in experimental clinical research, veterinary medicine and current research. At Annex Publishers, we tend to publish quality articles and try our best to provide the most effective analysis journal to the scientific community.
Abstract
A person's stature is an identifying characteristic that is often used in forensic investigation. Footprint is the one of the valuable physical evidence encountered in the crime scenes and examination of barefoot impressions is important especially in developing countries like India, Malaysia where majority of the rural population like to walk barefooted because of socio-economic and climatic reasons. Foot impressions are still found at crime scenes, since offenders often tend to remove their footwear either to avoid noise or to gain better grip in climbing walls, etc., while entering or exiting. Most of the foot/foot print studies were conducted on mixed population. The researchers have cautioned that the people from different races and regions of a country bear different morphological features depending upon their geographical distribution and primary racial characteristics and hence a single formula cannot represent all parts of that country or world. The present study aims to estimate stature from bilateral footprints collected from 320 (160 males, 160 females) consenting adult Ibans, an indigenous group residing in Sarawak state, east Malaysia. Informed consent and Human Ethical Approval were obtained. The height of the individuals and footprints were collected following the standard procedure. The data obtained were analyzed with PASW 20 computer software and derived regression formulae to estimate stature from footprint lengths of Iban ethnics. The result of the investigation revealed that all footprint lengths exhibit statistically positive significant correlation with stature (p< 0.001). Correlation coefficient (R) values are found to be higher in the pooled sample (0.861–0.887) when compared with males (0.753–0.789) and females (0.728–0.790). The regression formulae derived for the pooled sample can be used to estimate stature when the sex of the footprint remains unknown, as in real crime scenarios.
Abstract
Age estimation of unknown human cadavers is important in setting a crime investigation, such as homicide, suicide or in mass disaster because it can guide forensic investigators to the correct identity among a large number of possible matches. More and more the courts ask for medico-legal age estimations of unknown human cadavers by forensic dentistry. This research project in establishing the applicability of radiographic and morphological parameter's used in forensic dentistry in a Portuguese adult population. The main goal is to compare the chronological age with the dental age estimation by radiographic and morphological parameters. To achieve this objective, thirty-five single-rooted teeth were analysed. Radiographic analysis was made through the program of digital radiology software Kodak RVG intra-oral 2200 with exposure factors 60-70 KVp and 7mA. The morphological parameter, translucent dentin was assessed in intact and sectioned tooth. The relationship between the coefficients was calculated between the age and the ratios with the level of inclusion, p< 0.05. There was no statistically significant difference between the chronological age and the age estimation by each method. The coefficient of Pearson for the direct measurements of the translucent dentin methodology for sectioned teeth gives the better correlation with the age estimate (r=0.86).
Journal of Nutrition and Health Sciences is an open access journal that publishes peer reviewed research articles and short communications in all aspects of nutrition. This Journal encompasses the full spectrum of nutritional science including nutritional requirements, public health nutrition, epidemiology, dietary surveys, body composition, energetics, appetite, obesity, ageing and metabolic studies.
Journal of Forensic Science & Criminology (JFSC) is an open access, significant and reliable source of contemporary knowledge on advancements in the field of forensic science. JFSC publishes peer reviewed research articles, critical reviews and short communications focused on forensic science and criminology. JFSC encompasses the full spectrum of forensic science including forensic biology, forensic chemistry, cyber forensics and crime scene investigation
Journal of Genetic Mutations and Disorders (JGMD) is an open access, peer reviewed journal which provides advanced researches including Genetics of Infectious Diseases, Genealogical Tracing, Stem Cell Research, Gene mapping with three-point crosses, Genetic linkage and genetic maps. JGMD publishes original research, review articles in all aspects of genetic mutations and disorders
Childhood obesity has been described as the main health-related problem in developed countries, due to its link with physical, social and psychological consequences with an increased risk for developing metabolic and cardiovascular diseases in adulthood.
All the pupils of both sexes attending the second year of all the primary schools in Pavia, Northern Italy, were recruited (n=470) for this study. Measurements of weight, height and waist circumference (WC) were taken under standard conditions. Body Mass Index (BMI) and waist-to-height-ratio (W/HtR) were computed and sex specific percentile values for BMI, WC and W/HtR were calculated and compared with the same percentiles available for different countries.
The results show that according to Cole’s cut-off point reference standards, 12.5% and 9.0% of boys and girls respectively are overweight, 4.7% and 5.2% respectively are obese. The WC mean value is equal to 60.0 ± 6.0 cm in boys and 59.0 ± 6.7 cm in girls. Using different 90th reference worldwide standard percentiles for WC as a comparison, the prevalence of our children with WC > 90th percentile is very different. The W/HtR mean value of the total sample is 0.46 ± 0.03. Assuming a cutoff of 0.5, 87.6% of the pupils have a W/HtR value ≤ 0.5, while 12.4% of the subjects have a value > 0.5, showing abdominal obesity among 55 children at an early age.
Our results point out the need for specific preventive and treatment interventions by identifying and implementing effective strategies, policies, and nutritional education programs in order to decrease the prevalence rate of obesity as well as the risk of metabolic disorders.
Quantitative Analysis of 30 Drugs in Whole Blood by SPE and UHPLC-TOF-MSAnnex Publishers
Abstract
An Ultra-High Pressure Liquid Chromatography Time-of-Flight Mass Spectrometry (UHPLC-TOF-MS) method for quantitative analysis of 30 drugs in whole blood was developed and validated. The method was used for screening and quantification of common drugs and drugs of abuse in whole blood received from autopsy cases and living persons. The compounds included: alprazolam, amphetamine, benzoylecgonine, bromazepam, cathine, cathinone, chlordiazepoxide, cocaine, codeine, clonazepam, 7-aminoclonazepam, diazepam, nordiazepam, flunitrazepam, 7-aminoflunitrazepam, ketamine, ketobemidone, 3,4-Methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine, methadone, morphine, 6-monoacetylmorphine, nitrazepam, 7-aminonitrazepam, oxazepam, temazepam, tramadol, O-desmethyltramadol, and zolpidem. Blood samples (200 μL) were subjected to Solid Phase Extraction (SPE). Target drugs were quantified using a Waters ACQUITY UPLC system coupled to a Waters SYNAPT G2 TOF-MS apparatus. Extraction recoveries ranged from 41% (7-aminoclonazepam) to 111% (ketamine) and matrix effects ranged from -13% (temazepam) to 50% (7-aminonitrazepam). For all compounds, a quadratic polynomial was applied for fitting the calibration curves. Lower Limits of Quantification (LOQ) ranged from 0.005 to 0.05 mg/kg. Satisfactory precisions below 15% and accuracies within 85-115% were obtained for all compounds at concentrations exceeding the LOQ. In conclusion, we present a validated UHPLC-TOF-MS method for simultaneous quantification of 30 drugs in whole blood with a run time of 15 min using 200 μL of whole blood.
Keywords: Drugs of abuse, UHPLC-TOF-MS, Whole blood, SPE, Quantification
The flesh-fly-sarcophaga-(liopygia)-crassipalpis-macquart-1839-as-an-invader-...Annex Publishers
Abstract
We present an indoor forensic case that occurred in spring 2013 in Cosenza (southern Italy). The entomological evidence collected at the scene consisted of Calliphoridae (Calliphora vicina, Lucilia sericata), Sarcophagidae (Sarcophaga crassipalpis), Fanniidae (Fannia scalaris) and Muscidae (Hydrotaea ignava). The minimum Post Mortem Interval (mPMI) was calculated by relating the entomological evidence to data available for Diptera species in the area and to our knowledge of the development of flies used as forensic indicators in Calabria. We report S. crassipalpis as a corpse invader for the first time in Italy.
Keywords: Forensic case; Flies; S. crassipalpis; mPMI; Southern Italy
Abstract
Here in a systematic, accurate and reliable method, Head-Space Gas Chromatography-Mass Spectrometry (HS-GC/MS) was developed to determine blood carboxyhemoglobin (COHb%), in order to investigate deaths related to CO exposure especially involving blood and hepatic tissues. Using a column packed with molecular sieve, COHb levels were quantified down to 0.2% in small blood samples quickly and showed good reproducibility with RSD of the COHb < 1%. COHb% in hepatic samples stored at different temperatures (-20 °C for 1- 2 years, 0 °C, and 18 °C for two months) can be determined even when the samples are decomposed. The 3-min procedure requires only 0.25 mL of blood sample or 1.0 g of hepatic tissue each time. The technique has a clear advantage over other methods such as UV spectrophotometry.
Keywords: Carbon monoxide poisoning; COHb; Decomposed hepatic tissues; Headspace gas chromatography/mass spectrometry (HS-GC /MS)
Annex Publishers, as an Open Access publication model allows the dissemination of research articles to the worldwide community. We offer you the advantage of interaction with the most effective minds from the scientific community. All articles printed under open access will be accessed by anyone.
www.annexpublishers.com
Abstract
Rocky Mountain spotted fever, Rickettsia Rickettsii (RMSF) is a reoccurring disease in Arizona and Sonora and a public health problem due to the high risk medical complications it provokes. In the region it is transmitted by the bite of the Rhipicephalus sanguineus tick, found in dogs. This tick transmits Rickettsia rickettsii bacteria. Following an incubation period of 3-14 days, it causes acute, non-specific effects early on (fever, headache and rash) that -if not diagnosed and treated in time can be serious or cause death. Death is primarily associated with two factors: (a) delay in diagnosis, and (b) doxycycline, a highly effective antibiotic treatment which is inexpensive and simple to administer is delayed. If doxycycline is not provided before the 5th day after the symptoms begin, the patient can worsen and present with dark purple spots on the body, mostly hands and soles, wrists and ankles as well as have heart, hepatitis, renal, central nervous symptoms and other multiple organ complications. RMSF should be considered a medical priority and a public health problem at the regional level with a network of underlying factors. To prevent and control RMSF in Arizona and Sonora, public health interventions will need to address medical challenges associated with a number of social, political, and environmental factors.
In this study, we focused on the effect of β-glucan supplementation of children with chronic respiratory problems. We measured the levels of cortisol, salivary IgE and cotinine in 56 children and evaluated the effect of 30 day supplementation with 100 mg/day oral dose of yeast-derived β-glucan. Our results showed strong decrease of cotinine and cortisol levels in saliva of β-glucan-supplemented children. The increase of total salivary IgE levels in both groups was not statistically significant. The positive effects of complex curative treatment using β-glucan were accompanied by increased physical endurance and by significant reduction of negative clinical problems of affected children.
Causes for syncope are multifaceted. Hormonal etiology, specifically hypothyroidism, is associated with cardiac arrhythmias [1]. Sinus bradycardia, low voltage, nonspecific T-wave changes and dissociative atrioventricular (AV) abnormalities are some of descriptive electrocardiographic features [2]. In the majority of well know clinical presentations complete AV block requires the insertion of a permanent pacemaker. However hypothyroidism related bradycardia and consequential symptomatic AV blocks could be reversible with timely and proper management.
We report a case of severe hypothyroidism resulting in insertion of transient pacemaker with favorable clinical course and fully reversible complete AV block after accordant pharmacological hormonal substitution.
Journal of Proteomics & Geneomics (JPG) is an instructional journal providing a chance to researchers and scientists to explore the advanced and latest research developments within the field of Proteomics and Geneomics. Journal of Proteomics & Geneomics publishes the best quality scientific articles amalgamating broad vary of fields together with the fields associated with Proteomics & Geneomics.
Journal of Obesity and Overweight (JOO) is a peer reviewed open access journal. It is dedicated to increase knowledge, fostering research, and promoting better treatment for people with obesity. It includes subjects like nutrition medicine, clinical nutrition medicine, genetics and nutrition, biophysics and lipid metabolism, etc. It aims to publish advanced research works related to public health and medical developments.
Journal of Computational Systems Biology (JCSB) is an open access online journal which aims to publish peer reviewed research articles and short communications in all aspects of computational biology and bioinformatics. JCSB comprehend the broad spectrum of computational bioscience including biological databases and bioalgorithms.
Journal of Biometrics and Its Applications (JBIA) is peer reviewed open access journal which addresses the fundamental areas in computer science that deal with biological measurements. It covers both the theoretical and practical aspects of human identification and verification. Biometrics based authentication, an integral component of identity science, is now being utilized in several applications playing a central role in personal, national and global security. Biometric refers to the field of development of statistical and mathematical methods applicable to data analysis problems in the biological sciences.
Journal of Gynecology Research (JGR) publishes original articles and research studies on, scientific advances, new medical and surgical techniques, obstetric management, and clinical evaluation of drugs and instruments and all aspects of gynecology including gynecological endoscopy, infertility, oncology contraception, urogynecology, fertility, and clinical practice and ultrasonography. It aims to publish the highest quality medical research in women's health, worldwide.
CLINICAL AND EXPERIMENTAL RESEARCH IN CARDIOLOGYAnnex Publishers
Journal of Clinical and Experimental Research in Cardiology (JCERC) is an international open access, scholarly peer-reviewed journal publishing high quality articles in all areas of cardiology related fields, especially current research, new concepts, novel methods, new therapeutic agents, and approaches for early detection and prevention of cardiac disorders and reporting new methods on basic and advanced clinical aspects of cardiology research.
CLINICAL AND EXPERIMENTAL RESEARCH IN CARDIOLOGYAnnex Publishers
Journal of Clinical and Experimental Research in Cardiology (JCERC) is an international open access, scholarly peer-reviewed journal publishing high quality articles in all areas of cardiology related fields, especially current research, new concepts, novel methods, new therapeutic agents, and approaches for early detection and prevention of cardiac disorders and reporting new methods on basic and advanced clinical aspects of cardiology research.
Journal of Bioequivalence Studies (JBS) is an open access, peer reviewed journal that publishes the most relevant and reliable researches with respect to the subject of Bioequivalence studies which includes pharmacokinetic and pharmcodynamic properties of a drug. JBS publishes original articles, review articles, case reports, short communications, etc.
Anti arthritic-efficacy-and-safety-of-crominex-3+(trivalent-chromium-phyllant...Annex Publishers
Abstract
The present investigation was undertaken to evaluate the therapeutic efficacy and safety of Crominex® 3+ (a complex of trivalent chromium, Phyllanthus emblica (Amla) extract and purified Shilajit) in moderately arthritic dogs. Eleven client-owned moderately arthritic dogs in a randomized double-blinded study received placebo or Crominex® 3+ twice daily for a period of 150 days. On a monthly basis, each dog was evaluated for arthritis associated pain (overall pain, pain upon limb manipulation and pain after physical exertion) and a full physical exam (body weight, body temperature and heart rate). At the same time intervals, dogs serum samples were examined for biomarkers of kidney (BUN and creatinine), liver (bilirubin, ALT and AST) and heart and skeletal muscle (CK) functions. Findings of this investigation revealed that dogs receiving Crominex® 3+ (1000 μg chromium, 15 mg Amla extract and 15 mg purified Shilajit per day in two divided doses) exhibited a significant (P< 0.05) reduction in arthritic pain noted as early as after 90 days with a maximum reduction after 150 days of treatment. Pain level remained the same or slightly increased in the dogs receiving placebo. No significant change occurred in physical parameters or serum biomarkers in dogs on placebo or Crominex® 3+, which suggested that Crominex® 3+ was well tolerated by arthritic dogs. In conclusion, Crominex® 3+ significantly (P< 0.05) ameliorated arthritic pain and improved quality of life without causing any untoward effects in moderately arthritic dogs.
Abstract
The objectives of this retrospective study were 1. To determine the effect of three surgical techniques (right flank omentopexy, right flank omentoabomasopexy, and left flank abomasopexy), and 2. To determine the effect of concurrent disease on return to normal milk production. Return to normal milk production occurred in 86.3% of cows diagnosed with LDA. Results suggested that cattle diagnosed with LDA corrected via right flank omentopexy or left flank abomasopexy were significantly more likely to return to normal milk production as compared to those corrected via right flank omentoabomasopexy (p< 0.02). No significant difference in return to normal milk production was noted between surgical techniques for correction of RDA (p=1.000) and right abomasal volvulus (p=0.596). Concurrent disease diagnoses did not affect return to milk production. Reported complications were infrequent (n=11).
List of abbreviations: LDA- Left displaced abomasum; RDA- Right displaced abomasum; RAV- Right abomasal volvulus; RAOV- Right abomasal-omasal volvulus; RFO- Right flank omentopexy; RFOA- Right flank omentoabomasopexy; LFA- Left flank abomasopexy; DA – Displaced Abomasum
Abstract
Three surgical case reports are presented to demonstrate the clinical efficacy of using an improved aqueous solution of chlorine dioxide complex (160 ppm) as a topical antiseptic in the post operative management of serious wounds in dogs. In vitro studies are included to demonstrate the antiseptic properties of this new chlorine dioxide complex.
Keywords: Chlorine dioxide; Antiseptic; Antimicrobial; Wound management
Abbreviations: ClO2-Chlorine dioxide; Cl2-Chlorine; PPM-Parts Per Million; SPP-Species; TEM-Transmission Electron Micrograph
Abstract
Salmonella is a causative agent for a wide variety of pathological diseases in humans, cattle, poultry and other farm animals and hence Salmonella infections are a major cause of concern to humans, veterinary animals and to food industry. With characterization of over 2500 Salmonella serovars, the pathogen nearly infects all vertebrates but the severity of infection varies from one serovar to another depending upon their host specificity. Some Salmonella serovars are restricted to one or few hosts while others have a broad host spectrum. Thus the understanding of the mechanisms involving host preference by one serovar over another is very important. As our knowledge about host adaptability will then be instrumental in designing better vaccines. Furthermore, methods involving identification of genetic markers for host specificity will prove to be instrumental in determining virulence factors for other pathogenic bacteria that cause systemic infections.
Keywords: Host adaption; Evolution; Salmonella serovar; Horizontal gene transfer
Anti inflammatory-and-anti-arthritic-efficacy-and-safety-of-purified-shilajit...Annex Publishers
Abstract
The objective of this investigation was to evaluate the efficacy and safety of purified Shilajit in moderately arthritic dogs. Ten client-owned dogs in a randomized double-blinded study received either a placebo or Shilajit (500 mg) twice daily for a period of five months. Dogs were evaluated each month for physical condition (body weight, body temperature, heart rate, and respiration rate) and pain associated with arthritis (overall pain, pain from limb manipulation, and pain after physical exertion). Serum samples collected from these dogs were examined each month for biomarkers of liver (bilirubin, ALT, and AST), kidney (BUN and creatinine) heart and muscle (creatine kinase) functions. The findings of this study revealed that dogs receiving Shilajit (Group-II) showed a significant (P< 0.05) reduction in pain from limb manipulation by day 60, and overall pain and pain after physical exertion by day 120. Maximum pain reduction, using all three criteria, was observed on day 150. Pain level remained significantly unchanged in dogs receiving the placebo. Dogs in either group showed no significant change (P>0.05) in physical parameters or serum markers, suggesting that Shilajit was well tolerated by moderately arthritic dogs. It was concluded that Shilajit significantly (P< 0.05) reduced pain in osteoarthritic dogs and markedly improved their daily life without any side effects.
Keywords: Purified Shilajit; Osteoarthritis in canine; Shilajit safety; Anti-arthritic nutraceutical
The updated-international-veterinary-anatomical-and-embryological-nomenclaturesAnnex Publishers
The international nomenclature of the anatomical, histological and embryological terms is known as Nomina Anatomica Veterinaria (N.A.V.), Nomina Histologica Veterinaria (N.H.V.) and Nomina Embryologica Veterinaria (N.E.V.).
This is the tripod of terms for the morphological sciences in our profession, a dictionary of terms used by all specialists in the basic and in the clinical sciences.
The discovery of the presence of stem cells and precursors with high regenerative potential in the mammary gland, hypothetically maintained throughout the course of the productive life of the dairy cow sheds an interesting perspective in the research which is interested to clarify all physiological clues and possible solutions to increase or maintain longer the potential production of dairy cows during life span of lactation. In 2006, Connie Eaves' lab in Vancouver (Stingl et ., 2006) [1]
Abstract
Mitogen-Activated Protein Kinase (MAPK) pathway is a signal transduction pathway that functions in a wide range of physiological and pathophysiological cellular events including cell proliferation, differentiation, apoptosis, migration, inflammation, metabolic disorders and diseases. In skeletal muscle, it plays an essential role in muscle fiber specialization, muscle mass maintenance, damage induced muscle regeneration and muscle diseases. This review provides an overview of MAPK pathway and its pathophysiological role in skeletal muscle diseases with a primary focus on muscular dystrophy and atrophy.
Abstract
An examination experiment has been carried out to investigate whether fingerprint powder and lifting technique can recover and transfer latent fingerprints from human skin surfaces of dead bodies. For recovery Swedish Black powder and for transfer White Fingerprint Gelatine were used.
Donors placed fingerprints on the human skin surfaces. Finger marks were then in all cases recovered with Swedish Black powder. The procedure was repeated after 2, 3, 4 and 5 hours. Treated finger marks were secured and preserved as latent fingerprint evidence by lifting process. We recovered 8% finger marks suitable for further examination of all deposited samples on the human skin surfaces.
Study on-efficiency-of-protein-extractants-employed-for-human-origin-determin...Annex Publishers
Abstract
Human origin determination is an important aspect of blood grouping analysis in forensic science laboratories. In the present study, protein extractants like gel buffer, ammonia and saline employed for origin determination were evaluated and compared qualitatively and quantitatively for their role in the extraction of proteins from dried blood stained materials of human origin at regular time intervals. Qualitative and quantitative methods employing counter immunoelectrophoresis (CIE) and rocket immunoelectrophoresis (RIE) respectively were used to study the protein extraction efficiency of extractants. Ammonia, compared to gel buffer and saline extracted the proteins effectively. Maximum extraction of proteins was observed in 2-3 hours of sample. CIE demonstrated sharp precipitin bands with all samples of ammonia extractant compared to the samples of counterparts. RIE also revealed greater concentration of proteins in the ammonia extract compared to extracts of gel buffer and saline. These results provide evidence that ammonia serves as a better protein extractant for rapid determination of human blood origin.
Keywords: Forensic science; Forensic serology; Blood origin; Electrophoresis; Protein extractants; Immunoprecipitation
Abstract
Programming scripts were written for the statistical analysis of genetic data from simple cases and complex cases of undetermined paternity. The methods presented here involve algorithms constructed with R, an open-source and increasingly popular programming language used for calculations and statistics; these methods also involve conditional probability analysis, Bayes’ Theorem, and pedigree analysis. Previous computer programs for assessing probable paternity in complex cases of undetermined paternity have been written; however, only minimal or generalized formulas are described in the papers presenting these programs. Therefore, these previously published programs are difficult to understand for most forensic researchers. Here, we present the details of the calculations used to evaluate probabilities of paternity and the details of the R scripts used execute these calculations. These scripts were constructed not only for standard trio case where DNA typing of the mother, child, and the alleged father are available, but also for more complex cases where DNA typing of the alleged father is absent. In these more complex cases, the putative genotype of the alleged father is determined from the genotypes of his parents, his siblings, his wife, children known to be his biological children, or some combination of these people. This report provides concrete and orderly descriptions of the calculations and the R scripts so that each facet of this method is easily understood. Furthermore, access to these scripts will enable individual researchers to develop calculation systems of their own.
Keywords: Forensic mathematics; Paternity testing; R; DNA typing
Tame to-torture-psychosexual-correlations-of-sex-violence-and-tortureAnnex Publishers
Abstract
This paper discusses the psychosexual correlations and psychological consequences related to torture and behavioral acts that are fundamentally torturous. The influence of participation by learning and the relationship of acts to thought and thought to acts are further discussed to raise awareness to the effects of torture on the torturer. Theories from multiple disciplines are presented in an integrated context to examine the correlation between fundamental psychological principles associated with acts that are torturous in nature and, therefore, innately evil.
Keywords: Aggression; Crime; Criminology; Behavioral acts; Human behavior; Psychological effects; Psychology; Psychopathology; Psychosexual; Sex; Sex crimes; Sexuality; Torture; Violence
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Earliest Galaxies in the JADES Origins Field: Luminosity Function and Cosmic ...Sérgio Sacani
We characterize the earliest galaxy population in the JADES Origins Field (JOF), the deepest
imaging field observed with JWST. We make use of the ancillary Hubble optical images (5 filters
spanning 0.4−0.9µm) and novel JWST images with 14 filters spanning 0.8−5µm, including 7 mediumband filters, and reaching total exposure times of up to 46 hours per filter. We combine all our data
at > 2.3µm to construct an ultradeep image, reaching as deep as ≈ 31.4 AB mag in the stack and
30.3-31.0 AB mag (5σ, r = 0.1” circular aperture) in individual filters. We measure photometric
redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts
z = 11.5 − 15. These objects show compact half-light radii of R1/2 ∼ 50 − 200pc, stellar masses of
M⋆ ∼ 107−108M⊙, and star-formation rates of SFR ∼ 0.1−1 M⊙ yr−1
. Our search finds no candidates
at 15 < z < 20, placing upper limits at these redshifts. We develop a forward modeling approach to
infer the properties of the evolving luminosity function without binning in redshift or luminosity that
marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the
impact of non-detections. We find a z = 12 luminosity function in good agreement with prior results,
and that the luminosity function normalization and UV luminosity density decline by a factor of ∼ 2.5
from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical
models for evolution of the dark matter halo mass function.
This presentation explores a brief idea about the structural and functional attributes of nucleotides, the structure and function of genetic materials along with the impact of UV rays and pH upon them.
This pdf is about the Schizophrenia.
For more details visit on YouTube; @SELF-EXPLANATORY;
https://www.youtube.com/channel/UCAiarMZDNhe1A3Rnpr_WkzA/videos
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An interesting-coexistence-of-a-classical-nodular-and-an-adenoid-ulcerous-basal-cell-carcinoma-in-the-same-anatomic-location
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An Interesting Coexistence of a Classical-Nodular and an Adenoid-Ulcerous Basal Cell Carcinoma in the Same Anatomic Location
Tas B*1, Uyar M2 and Altinay S2
1Department of Dermatology, Bagcilar Research and Training Hospital Istanbul, Turkey
2Department of Pathology, Bagcilar Research and Training Hospital Istanbul, Turkey
*Corresponding author: Tas B, Department of Dermatology, Bagcilar Research and Training Hospital, Atakoy 7-8. Kısım, Martı Sitesi, 14/105, Bakırkoy, Istanbul, Turkey, Zip code: 34156, Tel: (+90) 212-4404000, Fax: (+90) 212-4404000, E mail: betulavc@yahoo.com
Case Report
Open Access
Citation: Tas B, Uyar M, Altinay S (2014) An interesting Coexistence of a Classical-Nodular and an Adenoid- Ulcerous Basal Cell Carcinoma in the Same Anatomic Location. J Case Rep Stud 2(1): 101. doi: 10.15744/2348- 9820.2.101Abstract
Basal cell carcinoma is the most frequent malignant tumor of the skin, and the most common carcinoma found in some countries. The main clinical subtypes of BCC are nodular, superficial, pigmented and morpheaform. The majority of the lesions appear on the head and neck, with a particular predilection on the upper central part of the face. Here we report a 62 year-old woman with two different morphological types of BCC which developed in the same area. The tumors have developed two months apart on the right paranasal region in close proximity. With the clinical examination and histopathological examination of punch biopsy specimens, the diagnoses of the lesions were confirmed as a nodular and an adenoid BCC. The tumors were totally removed with surgical excision. Neither recurrence nor new lesion was observed on the lesional or near areas in a 24-month follow-up period. To the best of our knowledge the presence of the two different morphological types of BCC in the same anatomical location has not been reported previously. Introduction
Basal cell carcinoma (BCC) is the most common malignant tumor of the skin which was first described by Jacob in 1827 [1]. It represents around 95% of non-melanoma skin cancers [1], 65% of epithelial tumors [2], and account for approximately 70% of all malignant diseases of the skin [3]. It peaks in the sixth decade and more frequently occurs in men [2]. The tumors are frequently located in sun exposed areas such as on the nose, eyelids, at the inner canthus of eyes, and in fair-skinned individuals who have Fitzpatrick skin types I and II [1,2]. On the other hand, both the diagnosis of BCCs and the number of patients who develop multiple BCC (mBCC) [1] have increased considerably in recent years [4]. It is speculated that the increase might be associated with the destruction of the ozone layer, the greater exposure to ultraviolet radiation and, increase in life expectancy and cancer awareness [1]. The multiple tumors can be seen as either multiple lesions on more than one anatomic location [5], or, the coexistence of the same [6,7] or different morphological types in the same [7] or very close location [6]. We also report an interesting case who had a nodular and adenoid BCC located very close to each other in the right paranasal region.
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ISSN: 2348-9820
Keywords: Basal cell carcinoma; Nodular; Adenoid; Rodent ulcer; Coexistence
The 62 year-old Caucasian woman was admitted to our outpatient clinic due to an unhealed wound and a small nodule on the right-side of the nose. She has Fitzpatrick skin type IV, and according to the history, the patient worked as a farmer under the sun since the age of 16. A small pink papule developed on the upper-right paranasal region 9 months ago. Two months later, a pruritic, crusted, small eczematous plaque developed just below the first lesion. The second lesion quickly became eroded whereas the first lesion took the form of a nodule. There was no history of exposure to ionizing radiation or trauma on the lesional site, intake of drugs containing arsenic, chronical inflammatory dermatoses or scarring. However, according to family history, the sister of the patient (she was 65 years old) had similar multiple lesions, and they were diagnosed as multiple nodular BCC 7 years ago. In the dermatological examination, a 9 mm-diameter, flesh-colored, hard, oval, telengiectatic nodule, and a 7 mm- diameter, small, pink, crusted ulcer that had a pearly periphery on the right paranasal region were seen (Figure 1a). The lesions were painless. The patient had no regional or systemic lymphadenopathy and no additional pathology. Punch biopsies were taken from both lesions. In the histopathology, a proliferation of basoloid epidermal tumor cells were observed. Whereas the nodular lesion had a classical palisading pattern in the periphery of individual tumor nests which were embedded in a fibrous stroma (Figure 2a,b), in the ulcerated lesion, basaloid cells were located radially in the periphery of gland-like islets (Figure 2d,e). The epidermis of the nodular lesion was slightly atrophic, and in the ulcerous lesion it was destroyed through to the dermis. Immunohistochemical stainingsCase
Received Date: May 29, 2014 Accepted Date: June 09, 2014 Published Date: August 18, 2014
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with anti-bcl-2 monoclonal antibody, S-100, epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) were performed to assist in the diagnoses of the tumors. Both tumors were only stained with bcl-2 positively (Figure 2c,f). The other staanings were negative. With the clinical and histopathological findings, the diagnoses of the lesions were made as nodular and adenoid-ulcerous BCCs. After the diagnoses, each tumor was removed by total surgical excision with a 0.5 cm safety margin under local anesthesia, and the skin defects were closed primarily. Postoperative histopathological examinations of the tumors did not show any subcutaneous tissue invasion, and their surgical margins were intact. Neither recurrence nor a new lesion was observed at the excision site or near areas on the postoperative 60th day (Figure 1b), and in a 24-month follow-up period.
Figure2: Histopathologies of the lesions: Nodular lesion (upper row) (HEX100 (a), HEX200 (b), bcl-2X200 (c)). Adenoid-ulcerous lesion (lower row) (HEX100 (d), HEX200 (e), bcl-2X200 (f)).
Figure1: The clinical views of the nodular and ulcerous lesions. Preoperative (a), and postoperative 60th day (b).
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BCC has been described as the most common malignant neoplasm of humans [3]. According to the previous data, the usual site of origin of BCC has been considered to be the surface epidermis [8]. However, there is considerable morphological heterogenity among BCCs [9]. Thereafter, it has been stated that the tumor may originate from the outer root sheath of hair follicles, and in the 2006 World Health Organization classification, BCCs were classified in the skin adnexal tumor group [8]. On the other hand, the identification of mutations in the patched-1 (PTCH-1) gene has provided important insights into the pathogenesis of BCC, and points to a key role in the Hedgehog (Hh) signalling pathway in its pathogenesis [10,11]. While Hh pathway dysregulation is common to essentially all BCCs, because of the existence of multiple histological subtypes, including superficial and nodular variants, it has raised the possibility that morphologically distinct BCCs may arise from different cellular compartments in the skin. Indeed, Grachtchouk et colliques showed the induction of a major mediator of Hh signaling. The mediator called “GLI2- activator” has been found in stem cells of resting hair follicles in mice. Moreover, it has been shown that a small subset of these cells in the lower bulge and secondary hair germ compartments are capable of developing a nodular BCC. Tumorigenesis significantly accelerates when the GLI2-activator was induced in growing hair follicles. Contrarily, induction of this mediator in epidermis have led to the formation of superficial BCCs, and expression of it at reduced levels contribute to the occurrence of some lesions resembling basaloid follicular hamartomas. Therefore, it has been suggested that the origin of the cell, tissue context (growing stages of hair follicles), and level of oncogenic signaling can determine the phenotype of Hh/Gli-driven skin tumors, with high- level signaling required for the development of superficial BCC-like tumors from interfollicular epidermis, and nodular BCC-like tumors from hair follicle stem cells [9]. On the other hand, genetic mutations in the PTCH gene at 9q22.3 have been described as the cause of nevoid BCC syndrome, in which BCCs usually develop at young ages. In addition, some hereditary syndromes such as xeroderma pigmentosum, Bazex-Dupre-Christol syndrome, Rombo syndrome, and certain genetic polymorphisms may increase the development risk of BCCs, including single nucleotide polymorphism in the genes encoding melanocortin-1 receptor, PTCH, glutation-S-transferase, and cytochrome P450. Also, the TP53 gene, which is classified as a tumor supressor gene, has been seen to alter by point mutations in 40-50% of sporadic BCCs [12]. Another factor in the development of BCCs is ionizing radiation, and the malignancy risk is greater in patients exposed to ionizing radiation before the age of 40 than afterwards, especially in the development of mBCCs [13]. Chronic exposure to inorganic arsenic compounds may induce BCCs, and these BCCs are often of the superficial type. Although the mechanism of its action is not known exactly, a free radical formation and epigenetic DNA changes have been speculated for the reason of the malignant transformation [12]. Immunosuppression is another etiopatogenetic factor for the development of BCCs. There are some case reports describing BCCs in patients who underwent solid organ transplantation, who have HIV/AIDS and hematopoietic malignancies [14]. Additionally, BCCs may develop in chronically damaged skin sites including vaccination scars, pressure sites of medical protheses and chronic inflammatory dermatoses (stasis dermatitis, persistent ulcers, radiodermatitis, lupus vulgaris) [12]. In the etiopathogenesis, the cumulative ultraviolet-B-radiation (UVB-R) with the repeated exposure to the sun over the years is the most important factor in the genetically predisposed patients, and there is a latent period of 20 to 50 years between the beginning of the first UVB-R damage and the formation of the lesion [10]. Scrivener et al. showed that BCCs were seen approximately at the age of 65 years in their study [15]. However, BCCs can also be diagnosed in covered areas such as breast, periungal region, palm, sole, buttocks and intertriginous areas with an incidence from 10 to 15%. The factors responsible for such anatomic distribution are not yet understood [1].
The number of patients who developed mBCC has been increasing in recent years [1,4]. Wallberg et al. stated that the presence of skin tumors in the family, and sunburn after the age of 60 were independent factors with the development of mBCC [4]. Kiisky et al. indicated that while the age and red hair were significant risk factors for developing a first BCC lesion, factors such as red hair, high educational level, and a first BCC lesion located on the upper extremities were associated with a significantly increased risk of developing multiple BCCs. The authors also stated that the people who developed BCC lesions after the age of 75 were significantly less likely to develop multiple lesions [16]. Husein-El Ahmed et al. reported a case who had three mBCCs that arose from a surgical scar after radiotherapy and they stated that an immunosuppression related to the therapy might have been responsible for the development of the mBCCs. Ferreira et al. reported a case with multiple pigmented BCCs located in the pubic area [6]. In addition, Eisenschultz et al. reported two cases with mBCC in which one had both nodular and pigmented subtypes in different locations, and the other had both types of lesions in close areas [7]. Our patient is 62 years old, and she has Fitzpatrick skin type IV. We did not find any etiological factors such as ionizing radiation, exposure to any carcinogen, immunosuppression, chronic skin wound or inflammation, scarring or previus trauma. In contrast to Wallberg et al., because of the presence of the history of mBCCs in the sister of the patient, we thought that the patient might have a genetic predisposition. Our patient was chronically exposed to the sun due to the fact that she worked as a farmer for 46 years. Therefore, we also thought that the long-term UVR exposure, and the delayed onset of the lesions in the advanced age of the patient might have been responsible for the accumulating UVR doses in the skin, and might have caused the development of these BCCs, which was consistent with the literature. Discussion
Most of the BCC lesions arise on the head and neck (75-86%) with a particular predilection on the upper central part of the face [17]. The others develop on the trunk (10%) [2] , and extremities or other anatomical areas [17]. There is a direct relation between occupational sun exposure and risk of head and neck BCCs, especially in the development of the nodular type [18]. The other main clinical types of BCC are superficial, cystic, pigmented and morpheaform types [11,17,19,20]. The superficial BCC generally arises on the trunk [2,19,20]. Therefore, some authors reported that truncal BCC is linked to a genetic susceptibility and a reduced DNA
4. repair capacity which increased the risk of BCC on the non-exposed areas [18]. In a recent study, the distribution of morphological subtypes of BCC was reported as 49% for nodular, 29% for mixed patterns, 13% for infiltrating, 7% for adenoid, 3% for micronodular, 1% for superficial, and 1% for basosquamous of 103 lesions. Additionally, the authors indicated that only 7 patients had mBCCs on more than one anatomic location, and almost all of the mBCCs were seen on the face and scalp [5]. Nodular BCC is the most common morphological type of BCC [8,12,19]. It begins as a small, waxy nodule that often shows a few small telangiectatic vessels on its surface. The nodule usually increases in size and often undergoes central ulceation. A typical lesion, then, consists of a slowly enlarging ulcer surrounded by a pearly, rolled border. This represents the so-called “rodent ulcer” [8,12]. Koyuncuer et al. showed that the ulceration was detected in 55.3% of all BCC types in their series.
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They also stated that the distributions of nodular subtypes according to anatomic locations were 76.9% on the face, 34.7% on the nose, 10.2% on the frontal region, and 10.2% on the orbital regions [5]. Both of the lesions of our case, were found on a sun- exposed area, and the placement of the lesions were consistent with the most frequent location of the BCCs. One of them was clinically the nodular type. Whereas noduler BCC often ulcerates as it enlarges, the nodular lesion of our case did not ulcerate although the lesion began 9 months ago. We thought that the reason for this condition might be related to the relatively small diameter of the lesion.
The second lesion of our patient was ulcerated clinically. Because of its presence near a nodular lesion and the fact that most BCCs can be ulcerated in the course of time, we firstly thought that the lesion might be a second, ulcerated nodular BCC. However, due to the presence of a proliferation of basoloid epidermal tumor cells on the periphery of the gland-like structures, this dagnosis was excluded. The adenoid type is one of the rare variants of BCCs [3]. It is also considered as a rare subtype of nodular disease [17]. The exact incidence of adenoid BCC is not known [21]. However, in the different studies the incidence has been indicated as 1.3% [21], 6.7% [22], 13.1% [23] and 20.91% [24]. This subtype does not have any particular site predilection [2]. However, Hussein et al. reported that the eyelids are preferential locations of adenoid BCC [22]. The other reported locations are face, scalp [5], axillae, back, iner cantus of eye, chin, forehead, and rarely cervix and prostate. The clinical presentations of previous cases have been reported as nodule, papulonodular sessile lesion, pigmented or brownish-black nodule, exophytic tumor, vegetating mass and ulcerative lesion. It is often regarded as a low-grade malignancy [2]. Contrarily, Goto M et al have shown in their recent study that it could invade into deeper tissues as a more invasive subtype of BCC [25]. Our patient indicated that the ulcerous lesion started like a pruritic eczematous plaque and then became rapidly ulcerated. The begining of the lesion (such as an eczematous plaque) did not resemble previously reported cases. However, with the histopathological examination, the diagnosis of adenoid BCC was confirmed. Our lesion was a diferentiated type and it did not invade into the deeper tissues. To the best of our knowledge, this eczematous plaque-like beginning of an adenoid BCC has not been reported previously.
BCC is usually divided into two main histopathological categories according to cell differentiation: differentiated (nodular, adenoid, keratotic, sebaceous) and undifferentiated (superficial, pigmented, infiltrative, sclerosing and micronodular) [20,22]. A sharp dividing line between the two groups cannot be drawn because many undifferentiated BCCs show differentiation in some areas, and most differentiated BCCs show areas lacking differentiation [8]. Additionally, there are some rare morphological variants of BCCs such as cystic, infundibulocystic and miscellaneous (clear-cell, signet ring cell, granular, giant cell, adamantanoid). These rare variants account for less than 10% of all BCCs [3]. Classically, a BCC is characterized by a proliferation of basaloid epidermal tumor cells with a palisading pattern in the periphery of the individual tumor nests, which are embedded in a fibrous stroma [12]. They usually show no pronounced variation in size or intensity of staining and no abnormal mitoses. On the other hand, adenoid variant is one of the differentiated types [8]. Hussein et al. stated that there was an incidence of only 6.67% of the adenoid BCC among all the histopathological types of BCC of the eyelids, and this variant in its pure form is less often seen [22]. The tumor cells of adenoid BCC show differentiation tubular, gland-like structures. These cells are arranged in intertwining strands radially around islands of connective tissue, resulting in a tumor with a lace-like pattern. The stroma has a mucoid appearance. In rare instances, lumina may be surrounded by cells that have the appearance of secretuary cells and the lumina may be filled with a colloidal substance or with an amorphous granular material. However definite evidence of secretuar activity of the lining cells have not been obtained, even with histochemical methods [8]. Each tumor of our patient had the typical histopathological features of their corresponding morphological types of the BCCs.
Even if the histopathological criteria still continue to be important in the histological diagnosis of a BCC, the immunohistochemistry is an adjunct technique for the differential diagnosis [3]. Also, it can be performed to identify the aggressiveness of the tumors [26- 29]. As prognostic factors in BCC, bcl-2 and p53 have been proposed. Bcl-2 expression was directly correlated with nonaggressive BCC and a favorable clinical follow-up, whereas the expression of p53 was correlated with the aggressive histotypes [27,28]. Moreover, the expression of the proliferation marker Ki67/MIB1 also directly correlates with aggressiveness [29]. Even though we could not perform the latter prognostic stainings (p53 and Ki67/MIB1), both lesions of our patient were stained positively with bcl-2, and they were differentiated and nonagressive types at least histopathologically.
In differential diagnosis of BCCs, a trichoepithelioma and especially its desmoplastic variant should be considered due to the clinical and histological similarities. The trichoepitheiomas have characteristic horny cysts and consist fully keratinized center surrounded by basophilic cells, but they have not high-grade atypia or mitoses. Tumor cells can be arranged in a lacelike or adenoid pattern [8]. In the adenoid BCC, the staining of the cytoplasms of the cells with bcl-2 is homogenous throughout the lesion but m-
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ore prominent at the periphery of the lesion. This feature is useful in differentiating BCCs from trichoepitheliomas [3]. Differentiation of BCC from squamous cell carcinoma (SCC) can sometimes be difficult. However, the fairly common presence in BCC of areas of retraction of the tumor from surrounding tissue, and deeply basophilic staining, aid in the diferentiation of BCC from SCC [8]. Another rare tumor with a similar histopathological picture is the cutaneous adenoid cystic carcinoma (ACC) which often originates in salivary glands. It is a firm, slow growing, ill-defined nodule commonly found on the scalp. Its cutaneous localization may also result from direct extension of ACC of minor salivary glands situated in the paranasal sinuses, and rarely a distant cutaneous metastasis of a primary salivary gland ACC. The tumors originating in salivary glands have local recurrence and widespread metastases; whereas cutaneous ACC is considered to be indolent or locally recurrent. Cutaneous ACCs are characterized by basaloid cells in the mid-to deep dermis in cords and tubules with a cribriform pattern, and few small cystic spaces containing mucinous material that stains positively for hyaluronic acid. Lack of connection to the overlying epidermis or adnexal structures and perineural invasion are important distinguishing features from adenoid BCC. Some observational evidence suggests that this tumor might be apocrine in origin. The other similar lesion to adenoid BCC is primary cutaneous cribriform apocrine carcinoma (CAC), which is a rare low-grade cutaneous apocrine carcinoma. Histologically, it is a non-encapsulated dermal tumor with a cribriform pattern. The aggregations of neoplastic cells are pleomorphic as opposed to the monomorphous appearance of BCC, and arranged in solid nests and tubules. In the lumina of tubules, some papillary protrusions of basophilic cells are seen. No perineural invasion is seen. It does not have metastatic potential or recurrence. Because of the lack of connection to the overlying epidermis, peripheral palisading of the basaloid islands of cells and retraction artefact of the surrounding fibrous stroma, the diagnosis of adenoid BCC can be excluded [3]. In the histopathologic examination, we did not see findings that suggested that the adenoid lesion was ACC or CAC.
BCCs generally show a favorable clinical behavior, but a percentage of them grow aggressively, infiltrating contiguous structures [30]. Infiltrative and micronodular tumors are more likely to be incompletely excised; thus they recur more frequently and are considered aggressive [31]. Treatment options of BCCs are topical 5% imiqoimod, 5-fluorourasil, curettage, cryotherapy, electrodesiccation and surgical excision [32,33]. We preferred surgical excisions for the therapy of each lesion. Conclusion
The development of the different mBCCs in the same anatomic location is a relatively rare condition. Multiple BCCs which had had the same or different morphological types of BCC located on the same or different areas have been reported previously. However, to the best of our knowledge, our patient, is the first case in literature regarding the coexistence of a nodular and an adenoid BCC in the same location in close proximity. Adenoid BCC is usually considered rare, differentiated and a low-grade malignancy. However, it sometimes can be locally invasive, so differentiating it from ACC and CAC can be difficult, even histologically. Making the correct diagnosis is crucial because of their prognostic differences. In addition, similarly to the previously mentioned mechanisms, we anticipate that the adenoid BCC can be originate from stem cells of rudimentary adnexal epithelium depending on the location and severity of oncogenic signals. We hope that the pathogenesis of the development of different BCC types, and other tumors originating from epidermal appendages will be enlightened in the future through the understanding of the exact role of GLI-activator-like mediators in the human skin. References
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