DNA methylation is the most well-studied epigenetic modification in cancer biology. 5-hydroxymethylcytosine is an epigenetic mark that can be converted from 5-methylcytosine by the ten-eleven ...translocation gene family. We recently reported the loss of 5-hydroxymethylcytosine in melanoma compared with benign nevi and suggested that loss of this epigenetic marker is correlated with tumor virulence based on its association with a worse prognosis. In this study, we further characterize the immunoreactivity patterns of 5-hydroxymethylcytosine in the full spectrum of melanocytic lesions to further validate the potential practical application of this epigenetic marker. One hundred and seventy-five cases were evaluated: 18 benign nevi, 20 dysplastic nevi (10 low-grade and 10 high-grade lesions), 10 atypical Spitz nevi, 20 borderline tumors, 5 melanomas arising within nevi, and 102 primary melanomas. Progressive loss of 5-hydroxymethylcytosine from benign dermal nevi to high-grade dysplastic nevi to borderline melanocytic neoplasms to melanoma was observed. In addition, an analysis of the relationship of nuclear diameter with 5-hydroxymethylcytosine staining intensity within lesional cells revealed a significant correlation between larger nuclear diameter and decreased levels of 5-hydroxymethylcytosine. Furthermore, borderline lesions uniquely exhibited a diverse spectrum of staining of each individual case. This study further substantiates the association of 5-hydroxymethylcytosine loss with dysplastic cytomorphologic features and tumor progression and supports the classification of borderline lesions as a biologically distinct category of melanocytic lesions.
Instructional methods for teaching medical students to recognize common skin lesions vary widely. There is little published data comparing various teaching methods and their impact on medical student ...retention of dermatologic knowledge.
Our prospective cohort study analyzed how teaching methods (interactive teaching versus. traditional didactic teaching versus. self-guided review alone) impacted second year medical students' ability to recognize common skin lesions one year after initial exposure to the material. Our study also looked at student satisfaction with different teaching methods.
There was no significant difference in long-term retention of knowledge between different teaching methods. However, students preferred the interactive format over the traditional didactic format. Spaced review is important for long-term retention, but an in-class review session two months after content was initially taught provided no added benefit over spaced self-review alone.
Medical students are able to maintain long-term retention of dermatologic knowledge irrespective of in-class teaching method. Repeat exposure to material is important but self-review of dermatology alone is sufficient for long-term retention. Dermatology course directors should incorporate interactive teaching into medical school curricula to increase learner satisfaction.
Objectives
We illustrate the important and troubling issue of persistent misinformation and false claims in the medical literature using a frequently cited case inaccurately believed by many to be ...the first case of calciphylaxis.
Methods
We identified a recurring error in the medical literature in the form of numerous citations of a study from the 1890s of a 6-month-old child with idiopathic infantile arterial calcification that is purported to be the first description of a case of calciphylaxis. We performed searches to determine the frequency of this error. Google Scholar and PubMed were searched for references citing the Bryant and White article. Accuracy of the citations was determined.
Results
A Google Scholar search identified 33 references that incorrectly cite the Bryant and White article as the first description of a case of calciphylaxis. Of the 100 most recent PubMed publications on calciphylaxis, we identified five studies that incorrectly attribute the Bryant and White article as the first description of calciphylaxis, which accounts for approximately 5% of the contemporary literature on this topic.
Conclusions
Medical misinformation such as this is frequently perpetuated. We propose that computational resources could be better used to flag erroneous and contradicted claims to update and correct the literature.
Neutrophilic dermatoses are a rare manifestation of systemic lupus erythematosus (SLE). In recent years, a growing body of literature describes a pathologic spectrum of neutrophilic infiltrates that ...may be seen in lupus patients. It is particularly important to recognize that neutrophilic dermatoses can be the initial manifestation of SLE in a third of patients. We were able to identify 47 patients with SLE associated with neutrophilic tissue reactions. In this review, we describe the histologic and clinical features of these cases in the hope that increased awareness of this unusual manifestation of SLE will generate prompt diagnosis and improved patient care.
Purpose: This study investigated the magnitude and consequences of educational debt for women physicians. Methods: Participants in a women's leadership course were surveyed. Results: Of the 185 U.S. ...physician respondents, 152 (82%) and 85 (46%) reported past debt and current debt, respectively. A total of 164 (89%) perceived a relationship between financial stress and burnout, although burnout scores did not vary by debt magnitude. One-fifth or more reported a negative past influence of debt on each of nine aspects of professional development or well-being. Conclusion: Educational debt has negative effects on the careers and well-being of women physicians.
Objective
We sought to determine whether viewing versus attending lecture impacted medical student course and licensing examination performance, grades on clinical rotations, perceptions of ...school-life balance, and comfort with clinical skills.
Methods
Optional anonymous questionnaires were emailed to all first-year medical students (class of 2020) at Boston University School of Medicine at the end of their first academic year and again to this same class after their first clinical rotation. A separate questionnaire was emailed to fourth-year medical students (class of 2019) midway through their final year.
Results
One hundred five (55.5%) and 69 (36.5%) students from the class of 2020 completed the first and second questionnaires respectively. Eighty-one (45%) students from the class of 2019 completed the third questionnaire. Students who attended 75% or more and viewed fewer than 50% of lectures were classified as attenders. Those who viewed 75% or more and attended fewer than 50% of lectures were classified as viewers. The others were grouped as mixed users. There were no significant differences between the groups in preclinical grades, United States Medical Licensing Examination scores, satisfaction with perception of school-life balance, and student-reported comfort with clinical skills. Viewers achieved a lower percentage of honors overall in core clerkships (
p
= 0.0001) with the greatest difference noted in the Internal Medicine clerkship.
Conclusion
Despite similar preclinical test scores and perceived comfort with clinical skills, the percentage of students earning honors grades in clinical clerkships was lowest in first-year lecture viewers.
Medical schools rarely offer exposure to clinical dermatology in the first-year curriculum.
We describe and report student satisfaction results of three novel teaching methods for integrating basic ...dermatology concepts into gross anatomy laboratory.
During the first year of the intervention, 180 students attended an hour-long anatomy laboratory session during which skin lesions were examined. One attending and three resident dermatologists spent time at all tables of students, then circulated to answer questions. During the second year, 189 students participated in the same teaching session preceded by a 30-minute in-class lecture. During the third year, 172 students were given the option to view a supplemental online video module before or after the teaching session. Each year following the teaching session, students were sent an optional online survey regarding the impact of the teaching session on their understanding of skin lesions and their cadaver experience.
Overall, students felt the intervention helped them develop a better understanding and appreciation for dermatology. Preceding the laboratory session with a lecture or educational video yielded higher satisfaction scores.
This brief teaching intervention illustrates an approach to introducing dermatologic entities within the foundational science curriculum of the first year of medical school.
Matrix metalloproteinases (MMPs) are key biological mediators of processes as diverse as wound healing, embryogenesis, and cancer progression. Although MMPs may be induced through multiple signaling ...pathways, the precise mechanisms for their regulation in cancer are incompletely understood. Because cytoskeletal changes are known to accompany MMP expression, we sought to examine the potential role of the poorly understood cytoskeletal protein, nestin, in modulating melanoma MMPs. Nestin knockdown (KD) upregulated the expression of specific MMPs and MMP-dependent invasion both through extracellular matrix barriers in vitro and in peritumoral connective tissue of xenografts in vivo. The development of three-dimensional melanospheres that in vitro partially recapitulate noninvasive tumorigenic melanoma growth was inhibited by nestin KD, although ECM invasion by aberrant melanospheres that did form was enhanced. Mechanistically, nestin KD-dependent melanoma invasion was associated with intracellular redistribution of phosphorylated focal adhesion kinase and increased melanoma cell responsiveness to transforming growth factor-beta, both implicated in pathways of melanoma invasion. The results suggest that the heretofore poorly understood intermediate filament, nestin, may serve as a novel mediator of MMPs critical to melanoma virulence.
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