Jonathan Rees

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..We set out to determine students' competence at skin lesion diagnosis and to quantify their clinical exposure to examples of such lesions during their dermatology attachment...

..Future larger studies are likely to provide more details of this process and may provide evidence for exactly which mechanistic pathways have mediated selection...

..Many of the genes found were previously known as underlying mutant mouse phenotypes or human genetic disease, but others, previously unsuspected as pigmentation genes, have also been discovered...

..I suggest that much medical research is best viewed as a form of engineering rather than science, and that the knowledge base and research funding for the amelioration of disease needs to be much more broadly based than at present...

..Recent advances in two areas that may prove relevant are discussed: new technological improvements in movement meters and compatible software; and some recently described animal models...

..What remains unclear are the mechanisms linking gene variation with sun sensitivity or tumor risk. In particular, it remains unclear whether pigmentary effects of the MC1R can account for all of the increase in cancer risk...

..Nor should they. In a new RCT, Kirke and colleagues have compared the therapeutic effects of different types of UVB radiation on clearance of psoriasis. Their study is unlikely to be the last word on this topic...

..How we can formally combine evidence from different traditions is, despite the claims of the evidence-based medicine movement, as yet unresolved...

..describe their use of mouse transgenics to demonstrate that the MC1R signaling pathway influences cancer risk via mechanisms in addition to pigmentation...

..Thus, a single locus, identified within a Mendelian framework, can contribute significantly to human pigmentary variation...

..If academic medicine is to continue to be attractive to the brightest and most interesting minds institutional change is unavoidable...

..Whether this conclusion is as a result of weakness in the statistical testing procedures applied, or whether it will be seen in other pigment genes will be of great interest for studies of human skin colour evolution...

..We need to think more about disease and less about genes; more in the clinic and less in the laboratory...

..At the same time, clinical discovery and patient-oriented research have become less common. Here, I suggest that these developments are interdependent, each representing the flip side of an inaccurate view of how clinical advance occurs...

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..88, P = 0.005). The products of the two NER genes, ERCC1 and XPF, where associations with melanoma were found, act together in a rate-limiting step in the repair pathway...

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..The experiments show that our proposed method integrating chromatic and geometric information produces segmentation results for pigmented lesions close to dermatologists and more consistent and accurate results for non-pigmented lesions...

..Although our numbers are small, our results extend previous work in man, and lead us to speculate that factors other than the amount of pheomelanin may be important in determining UVR susceptibility in persons with red hair...

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..It is argued that given advances in model systems, increases in technical facility, and the lower cost of genotype assessment, the lack of standardized phenotype assessment is now a major limit on advance...

..14 and 0.17 respectively. The proportion of variation explained is also greater at higher UVR challenge doses. Studies relating UVR sensitivity and pigmentation need to take account of the dose of UVR administered...

..The results provide important pharmacological characterization of common MC1 receptor variants in various world populations...

..This paper reviews the path of discovery of the MC1R in control of animal coat colour, the subsequent role of MC1R in human physiology and possibly wider role of MC1R in human skin carcinogenesis and human development through history...

..For comparison we also document overall photoadaptation and relate changes in pigmentation to the overall changes in photoadaptation...

..We could detect no consistent differences in ultraviolet radiation-induced erythema between the groups studied. The pharmacological mechanisms underpinning such prolonged inflammatory responses merit further investigation...

..Thus, we conclude that 'specific AHP' is a more specific marker of pheomelanin than is 'total AHP'...

..Accelerometers provide a useful and practical way of assessing scratching at night in the patient's own home and could be used as an objective measure of disease activity both in clinical trials and in everyday clinical practice...