Deprescribing strategies in older patients with heart failure.

Older patients with heart failure are particularly vulnerable due to a wide range of associated comorbidities, disability, and frailty. This population often receives multiple prescriptions, increasing the risk of adverse drug reactions, non-adherence, and drug interactions. Deprescribing, which involves reducing the number of medications to the lowest clinically reasonable limit, has the potential to decrease the risk of drug interactions and enhance patients' quality of life.

Positron Emission Tomography in Heart Failure: From Pathophysiology to Clinical Application.

Imaging modalities are increasingly being used to evaluate the underlying pathophysiology of heart failure. Positron emission tomography (PET) is a non-invasive imaging technique that uses radioactive tracers to visualize and measure biological processes in vivo. PET imaging of the heart uses different radiopharmaceuticals to provide information on myocardial metabolism, perfusion, inflammation, fibrosis, and sympathetic nervous system activity, which are all important contributors to the development and progression of heart failure.

Introduction to Head and Neck Melanoma: A Dermatologist's Perspective.

Melanoma is often initially evaluated by the dermatologist. A methodical evaluation requires complete history and detailed clinical physical examination and appropriate decisions regarding biopsies. Accurate diagnosis and staging require clinicopathologic correlation and an excellent relationship with the dermatopathologist.

Discrete Papular Lichen Myxedematosus and Scleromyxedema with Hypothyroidism: A Report of Two Cases.

Scleromyxedema and lichen myxedematosus (LM) are rare disorders that fall along the spectrum of primary cutaneous mucinoses. Scleromyxedema is a systemic form that classically presents with generalized waxy papules, sclerodermoid eruption, and monoclonal gammopathy; LM is a localized form limited to the skin that classically presents with white, firm, waxy papules and lacks monoclonal gammopathy. According to diagnostic criteria established in 2001, the diagnosis of both conditions requires absence of thyroid disease.

Disease stabilization with pembrolizumab for metastatic acral melanoma in the setting of autoimmune bullous pemphigoid.

Background: To date, patients with pre-existing autoimmune conditions have been excluded from immunotherapy trials out of concern for severe autoimmune exacerbations.

Case Presentation: We describe the first case of a patient with metastatic cKIT mutated acral melanoma, brain metastasis, and pre-existing severe autoimmune bullous pemphigoid (BP) with stable and asymptomatic disease 10 months after treatment with pembrolizumab. The patient experienced severe BP exacerbation after therapy with ipilimumab requiring systemic immune suppression, but nonetheless pembrolizumab was administered on further disease progression.

Exploiting time-independent Hamiltonian structure as controls for manipulating quantum dynamics.

The opportunities offered by utilizing time-independent Hamiltonian structure as controls are explored for manipulating quantum dynamics. Two scenarios are investigated using different manifestations of Hamiltonian structure to illustrate the generality of the concept. In scenario I, optimally shaped electrostatic potentials are generated to flexibly control electron scattering in a two-dimensional subsurface plane of a semiconductor.

Exploring the top and bottom of the quantum control landscape.

A controlled quantum system possesses a search landscape defined by the target physical objective as a function of the controls. This paper focuses on the landscape for the transition probability P(i → f) between the states of a finite level quantum system. Traditionally, the controls are applied fields; here, we extend the notion of control to also include the Hamiltonian structure, in the form of time independent matrix elements.

Why is chemical synthesis and property optimization easier than expected?

Identifying optimal conditions for chemical and material synthesis as well as optimizing the properties of the products is often much easier than simple reasoning would predict. The potential search space is infinite in principle and enormous in practice, yet optimal molecules, materials, and synthesis conditions for many objectives can often be found by performing a reasonable number of distinct experiments. Considering the goal of chemical synthesis or property identification as optimal control problems provides insight into this good fortune.

Attaining persistent field-free control of open and closed quantum systems.

Persistent quantum control (PQC) aims to maintain an observable objective value over a period of time following the action of an applied field. This paper assesses the feasibility of achieving PQC for arbitrary finite-level systems and observables. The analysis is carried out independent of the particular method used for state preparation.

Quantum control by means of hamiltonian structure manipulation.

A traditional quantum optimal control experiment begins with a specific physical system and seeks an optimal time-dependent field to steer the evolution towards a target observable value. In a more general framework, the Hamiltonian structure may also be manipulated when the material or molecular 'stockroom' is accessible as a part of the controls. The current work takes a step in this direction by considering the converse of the normal perspective to now start with a specific fixed field and employ the system's time-independent Hamiltonian structure as the control to identify an optimal form.

Exploring the capabilities of quantum optimal dynamic discrimination.

Optimal dynamic discrimination (ODD) uses closed-loop learning control techniques to discriminate between similar quantum systems. ODD achieves discrimination by employing a shaped control (laser) pulse to simultaneously exploit the unique quantum dynamics particular to each system, even when they are quite similar. In this work, ODD is viewed in the context of multiobjective optimization, where the competing objectives are the degree of similarity of the quantum systems and the level of controlled discrimination that can be achieved.

Multiple solutions in the tracking control of quantum systems.

This paper demonstrates the existence of multiple solutions at each time point in tracking control of quantum systems. These solutions are shown to arise from the nonlinear dependence of the short-time propagators U(t + delta t,t) on the control field. The multiplicity of solutions depends on the parameters of the controlled system and the nature of the imposed track.

Dermatologic and allergic conditions of the eyelid.

This article reviews the dermatologic and allergic conditions of the eyelid. Topics include various eyelid dermatitis, inflammatory lesions, infections, benign and malignant tumor, urticaria, vascular lesions, and others. Treatment considerations for these conditions of the eyelid are also discussed.

Lentigo maligna (melanoma in situ) treated with imiquimod cream 5%: 12 case reports.

Lentigo maligna (LM) is an in situ variant of melanoma. Although LM has the potential for invasion, it often has a greatly protracted radial growth phase and may remain indolent for years. The current standard of care is surgical excision, but this often results in substantial morbidity; thus, nonsurgical approaches continue to be investigated.

Photonic reagent control of dynamically homologous quantum systems.

The general objective of quantum control is the manipulation of atomic scale physical and chemical phenomena through the application of external control fields. These tailored fields, or photonic reagents, exhibit systematic properties analogous to those of ordinary laboratory reagents. This analogous behavior is explored further here by considering the controlled response of a family of homologous quantum systems to a single common photonic reagent.

Suggestions regarding a more appropriate understanding of atopic dermatitis.

Purpose Of Review: The importance of consistency and accuracy of medical terminology must be recognized by all health care providers and researchers. Yet, recent publications by recognized authorities regarding atopic dermatitis seem to defy that basic tenet. I (an allergist/dermatologist) have (objectively) reviewed and (subjectively) interpreted the currently (peer reviewed) published designations etymologically, and some of their concepts scientifically.

Effects of glucocorticosteroids on the skin and eye.

The dermatologic anachronistic adage, "If wet--dry it, if dry--wet it!" has bee perhaps justifiably replaced by "Call the dermatologist to prescribe a steroid!" To say this without knowledge of the contents of this article and more importantly, to accept such cliches, is a disservice to the patient and a litigious liability to the prescriber. Recognizing the risk/benefit ratio of the most commonly used anti-inflammatory agents is essential. All therapies are most effective when used for their specific diagnosis.

Urticaria: reassessed.

Urticaria is a common symptom--it is not a single disease. Patients present knowing what caused their "hives" or not knowing the cause of their hives. The latter patients present to the physician expecting to find a cause--but it is extremely rare that a single cause is discovered; however, a search for identifiable "triggers" should be sought in the history.

Occupational dermatoses.

Purpose Of Review: All terms referring to job-related (occupational) rashes are clearly defined. Ranking as the second most common occupational disorder, the importance of occupational dermatoses is illustrated.

Recent Findings: 90-95% of occupational dermatoses result from a contact-type dermatitis.

Atopic dermatitis.

Atopic dermatitis, the dermatologic manifestation of the atopic diathesis, has a variety of clinical presentations. This disease probably should be considered a syndrome--a group of signs and symptoms that frequently occur together in an identifiable pattern. The following update describes the spectrum of atopic dermatitis and summarizes current thinking about the etiology of the disease.

Pruritic dermatoses: overview of etiology and therapy.

This review begins with a brief survey of the neurophysiology and neuroanatomy of pruritus, and goes on to describe the etiology of the major allergic and nonallergic pruritic disorders. The etiology of pruritus often suggests the appropriate treatment. For example, urticaria, which is primarily mediated by histamine, is amenable to treatment with H1 antihistamines.

An overview of chronic urticaria.

Acknowledging urticaria as a symptom of mast cell degranulation is stressed. The biology of the mast cell, and the recognized immunologic and non-immunologic mast cell secretagogues are individually discussed along with mechanisms of activation and mediators released. The major, preformed mediator histamine in the skin produces a prototypic, short-lived urticaria, however, the clinical spectrum and pattern of "hives" indicate that other mediators contribute to the polymorphism and variable behavior of this symptom.