The thiazole/oxazole-modified microcins (TOMMs) represent a burgeoning class of ribosomal natural products decorated with thiazoles and (methyl)oxazoles originating from cysteines, serines and threonines. The ribosomal nature of TOMMs allows for the generation of derivative products from mutations in the amino acid sequence of the precursor peptide, which ultimately manifest in differing structures and sometimes, biological functions. Employing a TOMM system for the purpose of creating new structures and functions via combinatorial biosynthesis requires processing machinery that can tolerate highly variable substrates. In this study, TOMM enzymatic promiscuity was assessed using a currently uncharacterized cluster in Bacillus sp. Al Hakam. As determined by Fourier transform tandem mass spectrometry (FT-MS/MS), azole rings were formed in both a regio- and chemoselective fashion. Cognate and non-cognate precursor peptides were modified in an overall C- to N-terminal directionality, which to date is unique among characterized ribosomal natural products. Studies focused on the inherent promiscuity of the biosynthetic machinery elucidated a modest bias for glycine at the preceding (−1) position and a remarkable flexibility in the following (+1) position, even allowing for the incorporation of charged amino acids and bisheterocyclization. Two unnatural substrates were utilized as the conclusive test of substrate flexibility, of which both were processed in a predictable fashion. A greater understanding of substrate processing and enzymatic tolerance towards unnatural substrates will prove beneficial when designing combinatorial libraries to screen for artificial TOMMs that exhibit desired activities.

An unusual case of cutaneous angiosarcoma clinically mimicking eczema is described. A 98-year-old Caucasian male presented with a 6-month history of a flesh-colored, subcutaneous nodule on his left forehead with contralateral facial erythema and scaling that had been previously diagnosed as eczema. Despite treatments with topical steroids and moisturizers, the condition did not resolve. At our clinic, excisional biopsy of the forehead lesion and scouting biopsies from the contralateral cheek were performed which revealed cutaneous angiosarcoma. The described case illustrates that dermatitis-like features should be considered as a rare clinical manifestation of cutaneous angiosarcoma. It also demonstrates that these lesions may respond well to radiotherapy as a single modality.

These findings suggest an inherent appeal for audio-visual presentation and point its potential to improve patients' knowledge of their increased risk of skin cancer and preventive skin cancer measures.

A pyogenic granuloma (PG) is a rapidly growing benign vascular tumor that can be found on the skin or subcutaneous tissue. While some pyogenic granulomas may resolve spontaneously, most have a tendency to bleed easily and require treatment. Current therapeutic modalities include topical imiquimod, cryotherapy, electrodessication, curettage, excision, laser therapy, sclerotherapy, and microembolization. We report a recalcitrant case of chronic pyogenic granuloma occurring on the scalp of a healthy young male which was unresponsive to conventional surgical and non-surgical modalities. Ultimately, aggressive laser therapy, intralesional triamcinolone acetonide injections, and topical timolol application led to complete resolution and healing.

BACKGROUND Psoriasis is a chronic inflammatory skin and joints disease. Due to the complicated nature of this disease process, the layperson may have difficulty retaining the information in a short consultation visit with the physician. OBJECTIVE To evaluate a specialized outpatient clinic population knowledge about their psoriatic disease and promote better approaches. METHODS Participants in our study were randomized to two groups: pamphlet and video. Both educational media contained the same overall information. A questionnaire on basic concepts was given before and after the educational intervention to assess baseline disease knowledge and knowledge acquisition, respectively RESULTS A total of 74 patients (mean age 50.5 years) were enrolled and the educational material was considered useful by 66% of the participants. As to the knowledge acquisition, a good understanding of the noninfectious nature of the disease (97%) was demonstrated but understanding about the basic pathophysiology of the disease was poor (39%), 78% showed knowledge about the early signs of arthritis. After one year, patients retained knowledge and achieved similar score on same questions CONCLUSIONS The findings in our investigation are in line with those found in the literature and show that knowledge retention can be enhanced by written and video patient education, which can lead to better patient compliance and treatment adherence. CLINICALTRIAL Número do Parecer: 2.014.058 Pesquisador: DIMITRI LUZ FELIPE DA SILVA Área Temática: Versão: 3 CAAE: 62767416.5.0000.5404 Instituição Proponente: Hospital de Clínicas da UNICAMP Patrocinador Principal: Financiamento Próprio