We report on four patients who developed thickened skin on the neck and back after a long history of insulin-dependent diabetes mellitus. Pathogenesis, histology and methods of treatment are discussed.

These days, readers of the scholarly literature usually find what they want via keyword searching and are often unconcerned with which journal is carrying the article of interest. However, as authors they care very much about where their articles are published. This latest Annual Report of The Journal of Physiology is addressed to readers as authors looking for an appropriate home for their research. From this perspective, we review developments over the past year, present plans for the future and review the latest journal statistics. Our impactAmongst primary research journals in the Physiology category, The Journal of Physiology ranks first in Total Cites (46,154) and Cited Half-life (>10.0), second in Immediacy Index (1.386), Eigenfactor Score (0.08269) and Article Influence Score (1.91), third in number of articles published (420), and fourth in Impact Factor (4.881).Broader visibility of The Journal is reflected in the increased number of downloads made over the year. For the first time, the number of full text downloads has exceeded 5 million -an impressive achievement (Fig. 1). Journal contentThe Journal of Physiology continues to have a strong interest in all areas of physiology. The past 18 months have seen us follow our strategy (Paterson 2011) to reconnect with, and attract content from, research communities that have traditionally been The Journal's strongholds. In particular, neuroscience, biophysics and computational physiology (details below). Future initiatives for 2013 will focus on cardiovascular physiology with a call for submissions in molecular, cellular and integrative aspects of cardiac arrhythmia.Above and beyond these initiatives, we retain a keen interest in all original work that enhances our quantitative and mechanistic understanding of physiology irrespective of the spatial domain of study. Theoretical papers and papers that use computational models to further our understanding of physiological processes will be considered if based on experimentally derived data, and if the hypothesis advanced is directly amenable to experimental testing (see Extra information for modelling papers; http://jp.physoc.org/site/misc/author.xhtml#modelling). While emphasis is on human

We believe that the open-access model will be more sustainable than the traditional subscription model, under which journal prices have been rising faster than inflation and faster than library budgets for three decades [5,6]. Between 1970 and 1995, the average subscription price of a science, technology or medical journal increased by 471% [4]. Consequently, subscriptions by academic institutions as well as by individual academics have decreased sharply, which means that researchers have access only to a small percentage of all research in their field [7]. What do the article-processing charges pay for?As an open-access journal, Breast Cancer Research does not differ from traditional journals in its commitment to peer review or its way of conducting it. We take seriously the journal's "gate-keeping function" [1] to control and certify research quality. Article-processing charges will cover the cost of our high-quality peer review, copy-editing and publication, and ensure permanent world-wide, barrier-free, open access to the full text of research articles published in Breast Cancer Research.

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