Syphilis is usually a sexually transmitted infection caused by the spirochete Treponema pallidum. Primary syphilis classically presents as a painless, ulcerated lesion on the genitals. However, the primary lesion is not restricted to this site and appears wherever the spirochete enters through the skin. The symptomatology and appearance of the primary lesion can also vary. We present a case of a 59-year-old man with a primary syphilitic chancre of the lower lip. The patient was referred to the dermatology clinic by their primary care provider after the ulceration failed to heal with antibiotic therapy. A biopsy of the lesion was taken at this time; the diagnosis of syphilis was then made by histologic examination and immunohistochemical staining. Subsequent serologic tests were also positive. Upon prompting, the patient did report a history of sexually transmitted disease but not of syphilis specifically. The patient was treated with penicillin, and there was clinical improvement of the lesion at the follow-up visit.
Fifty-three RNA duplexes containing two single nucleotide bulge loops were optically melted in 1 M NaCl in order to determine the thermodynamic parameters ΔH°, ΔS°, ΔG°, and T for each duplex. Because of the large number of possible combinations and lack of sequence effects observed previously, we limited our initial investigation to adenosine bulges, the most common naturally occurring bulge. For example, the following duplexes were investigated: 5'GGCAXYAGGC/3'CCG YX CCG, 5'GGCAXY GCC/3'CCG YXACGG, and 5'GGC XYAGCC/3'CCGAYX CGG. The identity of XY (where XY are Watson-Crick base pairs) and the total number of base pairs in the terminal and central stems were varied. As observed for duplexes with a single bulge loop, the effect of the two bulge loops on duplex stability is primarily influenced by non-nearest neighbor interactions. In particular, the stability of the stems influences the destabilization of the duplex by the inserted bulge loops. The model proposed to predict the influence of multiple bulge loops on duplex stability suggests that the destabilization of each bulge is related to the stability of the adjacent stems. A database of RNA secondary structures was examined to determine the naturally occurring abundance of duplexes containing multiple bulge loops. Of the 2000 examples found in the database, over 65% of the two bulge loops occur within 3 base pairs of each other. A database of RNA three-dimensional structures was examined to determine the structure of duplexes containing two single nucleotide bulge loops. The structures of the bulge loops are described.
PROMIS (patient-reported outcome measures information system) is designed to track specific health domains across all diseases and disciplines. This study identified the relevance of three PROMIS domain outcomes in atopic dermatitis, acne, and psoriasis. A PROMIS health assessment, containing computer adaptive tests (CAT) for four domains (Anxiety, Mood, Pain Interference, and Physical Function), was administered on iPads during routine care in three Dermatology clinics at University of Rochester. Pain Interference, Mood, and Anxiety scores >55 were considered notable. All statistical analyses (ANOVA, chi square, fisher exact tests) were performed at significance level of 0.05 using JMP Pro12. Of 27,339 office visits, PROMIS data were captured for 4,523 visits. Domain order significantly influenced completion of the PROMIS health assessment. Completion rates were higher when Anxiety was first domain instead of Physical Function (73.4% vs. 63.5%, p<0.001). Age and gendermatched chart reviews of patients with notable and not notable domain scores revealed significant associations with certain diagnoses. Atopic dermatitis impacted physical health (i.e., Pain Interference), whereas acne and psoriasis impacted social health (i.e., Anxiety or Mood). Atopic dermatitis patients with notable Pain Interference had severe disease, higher percentage body surface area of disease, uncontrolled disease, and/or unsuccessful treatment (p<0.04). Acne patients with notable Anxiety had severe disease, scarring, and/or presence of mental health comorbidity (p<0.04). Psoriasis patients with notable Mood had severe disease, uncontrolled disease, unsuccessful treatment, and/or presence of mental health comorbidity (p<0.01). PROMIS domains capture clinically significant changes in patients physical and mental health associated with their dermatologic disease and treatment. The quality of patient-centered care in Dermatology may be improved with PROMIS utilization.
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