Purpose: To compare the effect of pathologic sentinel lymph node (SLN) status with that of other known prognostic factors on recurrence and survival in patients with stage I or II cutaneous melanoma.Patients and Methods: We reviewed the records of 612 patients with primary cutaneous melanoma who underwent lymphatic mapping and SLN biopsy between January 1991 and May 1995 to determine the effects of tumor thickness, ulceration, Clark level, location, sex, and SLN pathologic status on disease-free and disease-specific survival.Results: In the 580 patients in whom lymphatic mapping and SLN biopsy were successful, the SLN was positive by conventional histology in 85 patients (15%) but negative in 495 patients (85%). SLN status was the most significant prognostic factor with respect to diseasefree and disease-specific survival by univariate and multiple covariate analyses. Although tumor thickness and ulceration influenced survival in SLN-negative patients, they provided no additional prognostic information in SLN-positive patients.Conclusion: Lymphatic mapping and SLN biopsy is highly accurate in staging nodal basins at risk for regional metastases in primary melanoma patients and identifies those who may benefit from earlier lymphadenectomy. Furthermore, pathologic status of the SLN in these patients with clinically negative nodes is the most important prognostic factor for recurrence. The information from SLN biopsy is particularly helpful in establishing stratification criteria for future adjuvant trials. J Clin Oncol 17:976-983.

The microbial ecology of human skin is complex, but little is known about its species composition. We examined the diversity of the skin biota from the superficial volar left and right forearms in six healthy subjects using broad-range small subunit rRNA genes (16S rDNA) PCR-based sequencing of randomly selected clones. For the initial 1,221 clones analyzed, 182 species-level operational taxonomic units (SLOTUs) belonging to eight phyla were identified, estimated as 74.0% [95% confidence interval (C.I.), Ϸ64.8 -77.9%] of the SLOTUs in this ecosystem; 48.0 ؎ 12.2 SLOTUs were found in each subject. Three phyla (Actinobacteria, Firmicutes, and Proteobacteria) accounted for 94.6% of the clones. Most (85.3%) of the bacterial sequences corresponded to known and cultivated species, but 98 (8.0%) clones, comprising 30 phylotypes, had <97% similarity to prior database sequences. Only 6 (6.6%) of the 91 genera and 4 (2.2%) of the 182 SLOTUs, respectively, were found in all six subjects. Analysis of 817 clones obtained 8 -10 months later from four subjects showed additional phyla (numbering 2), genera (numbering 28), and SLOTUs (numbering 65). Only four (3.4%) of the 119 genera (Propionibacteria, Corynebacteria, Staphylococcus, and Streptococcus) were observed in each subject tested twice, but these genera represented 54.4% of all clones. These results show that the bacterial biota in normal superficial skin is highly diverse, with few well conserved and well represented genera, but otherwise low-level interpersonal consensus.human microbial ecology ͉ small subunit rRNA genes ͉ clone library ͉ microbial biota diversity ͉ normal human skin

Background Tens of thousands of health-related smartphone applications (apps), including hundreds of weight loss apps, are available but little is known about the effectiveness of these programs. Objective To evaluate the impact of introducing patients to a popular, free smartphone app for weight loss, MyFitnessPal, in a primary care setting. Design Randomized, controlled trial. Setting Two primary care clinics in the University of California Los Angeles Health System. Patients 212 primary care patients with body mass index greater than or equal to 25 kg/m2. Intervention 6 months of usual care (n = 107) or usual care plus research assistant help in downloading the MyFitnessPal app onto the patient’s smartphone (n = 105). Measurements Weight loss at six months (primary outcome), change in systolic blood pressure (SBP), change in behavioral mediators, satisfaction with the app, and frequency of app use (secondary outcomes). Results There was no significant difference between intervention and control groups in weight change (mean between group difference, −0.67 lb [CI, −3.3 to 2.1lb]; p = 0.63) or in SBP (mean between group difference, −1.7 mmHg [CI, −7.1 to 3.8]; p = 0.55). The intervention group exhibited increased use of a personal calorie goal compared to the control group (mean between group difference, 2.0 days per week [CI, 1.1 to 2.9]; p < .001), though changes in other self-reported behaviors did not differ between the groups. Most users reported high satisfaction with MyFitnessPal but logins dropped sharply after the first month. Limitation Despite blinding to the name of the app, fourteen control group participants (16%) used MyFitnessPal. 32% of intervention group participants and 19% of control group participants were lost to follow-up at 6 months. The app was given to patients by research assistants, not by physicians. Conclusion Smartphone apps for weight loss may be useful for individuals who are ready to self-monitor calories. For the average overweight primary care patient, however, introducing a smartphone app is unlikely to produce significant weight change.

Young men who have sex with men (YMSM) are at alarming risk for HIV acquisition, demonstrating the highest rates of incident infection of any age-risk group. GRINDR is a global positioning service-based social networking application popular with YMSM for sexual partnering. To assess the characteristics of YMSM who use GRINDR, we conducted a computer-assisted self-interview-based survey of 375 YMSM using GRINDR in metropolitan Los Angeles, recruited using the GRINDR platform. The median age was 25 (interquartile range, 22-27) years old, 42.4 % caucasian, 6.4 % African American, 33.6 % Latino, and 14.1 % Asian/Pacific Islander. Participants reported high rates of sexual partnering and unprotected anal intercourse (UAI). The majority (70 %) of those reporting unprotected anal intercourse reported low perception of HIV-acquisition risk. Of the participants, 83.1 % reported HIV testing within the past 12 months; 4.3 % had never been HIV tested. Of the participants, 4.5 % reported HIV-positive serostatus; 51.7 % indicated that they would be interested in participating in a future HIV prevention trial. Latinos were more likely than either caucasians or African Americans to endorse trial participation interest (odds ratio, 1.9; 95 % confidence interval [1.1-3.3]). HIV-positive test results were associated with increased number of anal sex partners in the past 3 months (adjusted odds ratio (AOR), 1.53 [0.97-2.40]), inconsistent inquiry about partners' serostatus (AOR,.64]), reporting the purpose for GRINDR use including "friendship" (AOR, 0.17 [0.03-1.06), and meeting a sexual partner in a bookstore in the past 3 months (AOR, 33.84 [0.99-1152]). Men recruited via GRINDR were high risk for HIV acquisition or transmission and interested in clinical trial participation, suggesting potential for this method to be used for recruitment of YMSM to HIV prevention trials.