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Background Immune-directed therapies have become front-line therapy for melanoma and are transforming the management of advanced disease. In refractory cases, multi-modal immunoncology (IO) approaches are being utilized, including combining immune checkpoint blockade (ICB) with oncolytic herpes viruses. Talimogene laherparepvec (T-VEC) is the first genetically modified oncolytic viral therapy (OVT) approved for the treatment of recurrent and unresectable melanoma. The use of IO in patients with concomitant malignancies and/or compromised immune systems is limited due to systematic exclusion from clinical trials. For example, a single case report of a solid organ transplant patient successfully treated with T-VEC for metastatic melanoma has been reported. Furthermore, the use of ICB in T-cell malignancies is limited and paradoxical worsening has been described. To our knowledge, this is the first report of dual ICB/T-VEC being administered to a patient with concurrent primary cutaneous anaplastic large cell lymphoma (pcALCL) and melanoma. Case presentation Here we present the case of a patient with concomitant primary cutaneous ALCL and metastatic melanoma, progressing on anti-programmed death (PD)-1 therapy, who developed Kaposi’s varicelliform eruption after receiving the first dose of Talimogene laherparepvec. Conclusion This case highlights the complexities of care of patients with coexistent cancers, demonstrates rapid progression of primary cutaneous ALCL on nivolumab and introduces a novel adverse effect of Talimogene laherparepvec.

Trachyonychia is a disease of the nail matrix that most commonly presents with sandpaper-like roughness of the nails. Retinoids are known to cause several nail abnormalities, likely due to their anti-proliferative effects. Despite this, no cases have been previously reported on the association of acitretin (second-generation retinoid) with trachyonychia. We present a single case of trachyonychia associated with acitretin that subsided following medication cessation.

Pityriasis lichenoides et varioliformis acuta (PLEVA) is a rare cutaneous eruption of erythematous macules and papules distributed over the flexural surfaces and the trunk. Histopathologic analysis is useful in diagnosis, and dermoscopic findings have been described in several small case series. We present a case of a mid-20s female who was diagnosed with PLEVA based on clinical and histopathological findings, and we also demonstrate a unique dermoscopic finding. Additionally, we review the current literature detailing dermoscopy findings with associated histopathology in PLEVA and pityriasis lichenoides chronica (PLC).

Maya Python for Games and Film is the first book to focus exclusively on how to implement Python with Maya. Written by trusted authorities in the field, this in-depth guide will help you master Maya Python, whether you're a seasoned technical artist looking to make the transition from MEL to Python or an aspiring artist not wanting to scramble for information.

Tumid lupus is a rare subtype of chronic cutaneous lupus that is characterized by urticaria-like photosensitive plaques. Unlike discoid lupus, it has minimal to no surface change and resolves without scarring. On pathological examination, it may be distinguished from other types of lupus by abundant interstitial mucin deposits. Herein, we describe a case of tumid lupus in a 23-year-old Kuwaiti male with hyper-IgM syndrome. To our best knowledge, this is the first report of tumid lupus in a patient with a primary immunodeficiency.

The importance of host defense against malignant melanoma is underlined by the use of immunomodulating agents as effective therapies. Diphencyprone and 2,4-dinitrochlorobenzene (DNCB) have been used successfully as contact sensitizing agents in this regard. Through haptenation of cell surface and cytoplasmic proteins, these agents trigger a CD8+ T-lymphocyte predominant allergic contact hypersensitivity response. Th17 cells may also play a critical role. The effectiveness of these agents at stimulating tumor defense may be limited to melanoma of the skin. Response to immunotherapy using diphencyprone and DNCB is governed by the immune status of the host, which is affected by tumor burden, UV light and age. Additionally, diphencyprone and DNCB elicit synergy with other methods of treatment and thus may be used as adjuncts. Two current prospective trials may aid in elucidating the impact that this treatment modality has on the prognosis and quality of life of patients with melanoma.

Autism spectrum disorder is one of the fastest growing neurological developmental disorders in the United States. Likewise, public schools have seen an increase in the number of students in special education with an eligibility category of Autism Spectrum Disorder. As school psychologists are among the most trained in assessments, it is essential they are well versed in autism assessment practices. Despite the growing need, there is little research on the practices of school psychologists when conducting an educational evaluation of autism. This study’s purpose was to utilize survey methodology to gather the autism assessment practices of practicing Colorado school psychologists. This information was then compared to “best practice” recommendations provided by the Colorado Department of Education among others. Using the same survey, this study also gathered Colorado school psychologist’s impressions and opinions on autism assessments in the schools. Participants were 52 regular, early career, and lifetime members of the Colorado Society of School Psychologists. Results indicated that many Colorado school psychologists are following best practices by considering outside evaluations, including parents and teachers in the assessment process, collecting developmental information, conducting observations across settings, and using a multidisciplinary approach. Results also showed that Colorado school psychologists can improve upon assessment practices by including outside therapists, talking directly with parents, interviewing students, and selecting appropriate autism-specific measures. Survey participants advocated for more training on autism assessment and intervention strategies. Survey results suggest that Colorado school psychologists need more support and training when conducting autism special education evaluations in the schools.

Civil asset forfeiture allows the government to seize and forfeit property that is associated with criminal activity without arresting or charging the property owner. Although expansive in its potential application, little is understood about the characteristics of civil asset forfeiture cases, the property owners involved in forfeiture cases, or the characteristics of any criminal cases pursued parallel to the civil cases. Utilizing open-source, public court records, this dissertation provides an exploratory analysis of these gaps in the literature by examining the types of civil asset forfeiture used, the value of asset forfeiture cases, how money from asset forfeiture is divided by the seizing agencies, the criminal charges and criminal case dispositions associated with asset forfeiture cases, and the racial and ethnic groups most impacted by civil asset forfeiture. The findings provide evidence of a substantial racial disparity in the application of civil asset forfeiture and call into question the crime control justification for civil asset forfeiture.

Esophageal adenocarcinoma is now the most common form of esophageal cancer, and the prognosis for patients with this disease is poor. Understanding the mechanisms of disease development through premalignant Barrett’s esophagus, a consequence of GERD, and factors predicting a positive response to treatment is necessary to improve outcomes. Vitamin D is a hormone that acts as an immunomodulator and regulator of cellular proliferation with anticancer properties, and has been implicated in the prevention of some cancers. Its main source in light skinned individuals is the sun, and there is an epidemiological association between increased exposure to ultraviolet irradiation and decreased incidence of esophageal adenocarcinoma. Refluxed acid and bile create an inflammatory milieu that in part may be mediated by 1,25(OH)2D by interacting with cyclooxygenase pathways, mitigating DNA damage, playing a role in bile acid metabolism, and influencing the immune cell population. 1,25-dihydroxyvitamin D may inhibit the Th1 response associated with reflux esophagitis while fostering the Th2 response associated with Barrett’s esophagus. Other immune cells including macrophages, dendritic cells, Th17 cells, and Tregs may be influential to the development or prevention of EAC, but their specific roles and interaction with 1,25(OH)2D is undefined. Hedgehog and NF-κB signaling are increased in BE and EAC, and although some interaction with 1,25(OH)2D may be present, it is difficult to credit this with a significant implication. The effects of 1,25(OH)2D are mediated by VDR. Vitamin D receptor is expressed in normal gastric cardia, Barrett’s esophagus, and esophageal adenocarcinoma, but absent in normal esophageal squamous mucosa. Staining intensity of VDR assessed by immunofluorescence correlates inversely with histologic grade, and staining is more intense in tissue that did not respond to neoadjuvant treatment, although no statistically significant correlations were found. Considering this, it is plausible that the extent of VDR expression is related to tumor progression and response to therapy, but it is equally as plausible that these data are merely random.