Citations

Despite major changes in US Graduate Medical Education, from Core Competencies (2002) to the Next Accreditation System (2012), few studies have evaluated the role of the Residency Coordinator in program accreditation. This role may be especially challenging in child neurology, which involves separate, accredited child and adult neurology residencies. The present study of Child Neurology Program Coordinators evaluated workforce factors and first-year implementation of new training requirements. The response rate was 65% (48/74). Concerning workforce features included high turnover, unpaid overtime, inconsistent job titles, limited career paths, inadequate training, and nonacademic supervision. Programs’ average implementation of 14 new accreditation items averaged 7.5 (standard deviation 2.5). This survey demonstrated that greater Next Accreditation System implementation is linked to increased coordinator experience, supervision within Graduate Medical Education, and greater administrative support for the coordinator role. Changes in these areas could improve future compliance of US child neurology programs with Graduate Medical Education accreditation requirements.

Objective. HIV and sexually transmitted disease (STD) surveillance patterns in Arizona suggested the need for integrated data analyses to identify trends. Methods. We compiled all HIV/AIDS cases diagnosed from 1998 to 2008 that were reported in Arizona and syphilis or gonorrhea cases diagnosed from 1998 to 2008 in Arizona. We used deterministic matching to identify individuals who were diagnosed with HIV and one or more STDs, and calculated time intervals between diagnoses. Results. Of 23,940 people with HIV/AIDS reported from 1998 to 2008, 1,899 (2.6%) had at least one syphilis or gonorrhea diagnosis from 1998 to 2008. Approximately 85% of these cases reported male-to-male sexual contact. Among males with syphilis, HIV coinfection increased from 0.5% in 1998 to 29.1% in 2008. Among males with gonorrhea, HIV coinfection increased from 2.0% in 1998 to 3.1% in 2008. Among HIV cases diagnosed from 2004 to 2008 and reported with at least one syphilis or gonorrhea diagnosis, the majority of syphilis cases (76.1%) were diagnosed at or after HIV diagnosis, whereas a majority of gonorrhea cases (54.9%) were diagnosed prior to HIV diagnosis. Conclusion. Use of the deterministic matching method identified increases in STD infections among HIV-infected people. The routine performance of this cross-matching method may be a useful tool in identifying these high-risk individuals so that targeted partner services and appropriate care referrals may be used in a timely fashion.

AbstractIntroductionWe hypothesized that common Alzheimer's disease (AD)‐associated variants within the triggering receptor expressed on myeloid (TREM) gene cluster influence disease through gene expression.MethodsExpression microarrays on temporal cortex and cerebellum from ∼400 neuropathologically diagnosed subjects and two independent RNAseq replication cohorts were used for expression quantitative trait locus analysis.ResultsA variant within a DNase hypersensitive site 5′ of TREM2, rs9357347‐C, associates with reduced AD risk and increased TREML1 and TREM2 levels (uncorrected P = 6.3 × 10−3 and 4.6 × 10−2, respectively). Meta‐analysis on expression quantitative trait locus results from three independent data sets (n = 1006) confirmed these associations (uncorrected P = 3.4 × 10−2 and 3.5 × 10−3, Bonferroni‐corrected P = 6.7 × 10−2 and 7.1 × 10−3, respectively).DiscussionOur findings point to rs9357347 as a functional regulatory variant that contributes to a protective effect observed at the TREM locus in the International Genomics of Alzheimer's Project genome‐wide association study meta‐analysis and suggest concomitant increase in TREML1 and TREM2 brain levels as a potential mechanism for protection from AD.

Osteosarcoma (OS) is a malignant bone tumor which is found primarily in adolescents, with the distal femur as the most common location. OS with a jaw primary is present in only about 10% of cases and the risk of recurrence is considered to be decreased in the jaw versus other primary locations. We present a unique case of a patient with localized OS of the jaw with an isolated recurrence in her bone marrow almost 5 years after completion of initial treatment.

ABSTRACTIntroductionEosinophilic fasciitis (EF) is a rare disorder that can present with muscle symptoms that mimic other neuromuscular diseases.MethodsWe report the case of a 43‐year‐old woman with chronic muscle aches, tightness, and stiffness with hypertrophied, well‐defined muscles despite physical inactivity, and thickened skin with reduced elasticity and discoloration.ResultsExcept for mild peripheral eosinophilia, laboratory studies, including blood count, electrolytes, paraneoplastic panel, muscle enzymes, thyroid function, and serum protein electrophoresis, were normal. Nerve conduction studies and needle electromyography were normal. Magnetic resonance imaging of the thighs demonstrated superficial and deep fascial thickening with T2 hyperintensity and post‐gadolinium enhancement. Fascial and muscle biopsy demonstrated an inflammatory exudate in the perimysium and endomysium with fragmented perimysial connective tissue and thickened, inflamed fascia. EF was diagnosed. The patient was treated with methotrexate and prednisone followed by improvement of muscle stiffness and tightness.ConclusionEF should be considered when patients present with muscle pain or enlarged muscles. Muscle Nerve 56: 525–529, 2017

Background Periodic acid Schiff‐diastase ( PAS ‐D) staining is used routinely in dermatopathology. Conventionally, parakeratosis or intracorneal neutrophils justify use of PAS ‐D stain to identify dermatophytosis. We aimed to investigate the histopathological features of superficial dermatophytosis. Methods Skin biopsies with PAS ‐D stain were retrospectively reviewed by a blinded dermatopathologist. Histopathologic findings in cases with dermatophytosis were compared with those without. Results We studied 110 cases, of which 63 were PAS ‐D positive for dermatophytes. Dermatophytes were identified on hematoxylin and eosin (H&E) staining in 49 (77.8%) of the PAS ‐D‐positive cases. Diffuse compact orthokeratosis (79.37%, p < 0.001) and focal parakeratosis (65.08%, p = 0.03) were significantly more frequent in dermatophytosis. Intracorneal neutrophils and spongiosis were not significant findings. Fungal elements were frequently observed within compact orthokeratosis (62.0%) and parakeratosis (31.8%) but rarely within intracorneal pustules (12.7%). In some dermatophyte cases, intracorneal neutrophils (47.6%) or parakeratosis (17.5%) were absent. Conclusions Compact orthokeratosis or focal parakeratosis justifies PAS ‐D staining, whereas the absence of intracorneal neutrophils or parakeratosis is insufficient to exclude dermatophytosis. Results indicate that having a low threshold to perform PAS‐D stain is justified. PAS‐D stain may be deferred until H&E slides have been evaluated.