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Skin cancer is a serious societal problem, and public awareness outreach, including to youth, is crucial. Medical students have joined forces to educate adolescents about skin cancer with significant impacts; even one 50-min interactive outreach session led to sustained changes in knowledge and behavior in a cohort of 1,200 adolescents surveyed. Medical students can act as a tremendous asset to health awareness public outreach efforts: enthusiastic volunteerism keeps education cost-effective, results in exponential spread of information, reinforces knowledge and communication skills of future physicians, and can result in tangible, life-saving benefits such as early detection of melanoma.

Rationale: Pegylation of interferon-alfa results in an improved pharmacokinetic profile by maintaining constant blood levels, resulting in higher sustained response rates (SVR). However, modification of interferon-alfa by pegylation also reduces biologic potency. Delivery of a bio-optimized alpha interferon in an unmodified form (consensus interferon, Infergen(r)) by continuous infusion can be expected to provide sustained and constant levels of a fitly potent protein. We hypothesize that such an approach may potentially result in greater antiviral activity and improved tolerability by avoiding wide swings in interferon levels. Methods:We conducted a phase 2 pilot study to assess the safety, tolerability and viral kinetics of Infergen (12 t~g/day) by continuous infusion using a subcutaneous infusion device (Medtronic MiniMed(r) pump) in combination with ribavirin (1000 mg or 1200 mg daily). The MiniMed model 508 micro infusion pump is deared for use in the treatment of diabetes. HCV RNA viral levels were measured at days 1, 3, 7, 10, 14, 21, 28 and then at weeks 6 and 12. Results: Among 10 nonresponders treated to date with Infergen by continuous infusion with available early viral kinetics data, 7 showed a substantial reduction in HCV viral levels (at least 1 logm reduction in 4, and 2 logm reduction in 3). All 7 of these patients were genotype 1 and 6 had less than 1.0 logm decrease with prior treatment while I had a 1.5 logm decrease at similar time-points with other combination therapy [either pegylated interferon/RBV (4 pts) or interferon-alfa/RBV (3 pts)]. No serious adverse events were reported and 3 patients discontinued (2 due to moderate interferon-related side effects and I due to inability to acclimate to the pump). Other patients continuing on study experienced mild adverse events that have been tolerable. Conclusions: Consensus interferon administered by continuous delivery via the Medtronic MiniMed pump shows early substantial reduction of HCV RNA levels among nonresponder patients and shows a good safety and tolerability profile. Updated data on a total of 22 patients (including 10 na/'ve genotype 1 patients) will be presented.

Nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, is a debilitating skin condition that causes fibrotic changes in the setting of renal failure. Gadolinium-based contrast agents (GBCA), erythropoietin (EPO), and vascular intervention are the most widely known associated factors in the pathogenesis. A 53-year-old female with chronic renal insufficiency secondary to fibrillary glomerulonephritis (FGN) presented with generalized hardening of skin 1 week after her renal transplant. Due to her numerous medical and surgical health problems, she had received six imaging procedures with GBCA with the last being eight months prior to the onset of her skin symptoms. She had also historically been treated with high doses of EPO. Histopathologic examination was consistent with NSF. In susceptible renal failure patients who develop NSF after GBCA exposure, the onset of symptoms is usually within a 2-3 month time frame, which undermines but not eliminates the proposed role of GBCA in our patient. It can be proposed that despite having various risk factors, while being exposed to high doses of EPO, vascular trauma during renal transplant facilitated the onset of her symptoms.