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Locoregional Recurrence in Sentinel Lymph Node–Positive Head and Neck Melanoma: A Retrospective Cohort Study Evaluating the Impact of Adjuvant Immunotherapy
No full textSkincare ingredients recommended by cosmetic dermatologists: A Delphi consensus study
No full textBACKGROUND: There is ambiguity regarding the topical cosmetic ingredients preferred for common skin complaints. OBJECTIVE: To determine which topical ingredients are frequently recommended by cosmetic dermatologists for fine lines and wrinkles, acne, redness, dark spots, large pores, dry skin, and oily skin. METHODS: Literature review to develop long list of ingredients. Reduced by expert panel to most salient ingredients. Two rounds of Delphi consensus survey with second expert panel of clinicians and teachers. Comparative literature review to summarize published evidence supporting each consensus ingredient. RESULTS: List of 318 ingredients reduced by a panel of 17 dermatologists to 83. Two Delphi rounds completed by 62 dermatologists at 43 centers. Consensus achieved for 23 ingredients, including the following: azelaic acid (acne, dark spots); benzoyl peroxide (acne, oily skin); glycolic acid (acne, dark spots); mineral sunscreen (fine lines and wrinkles, redness); niacinamide (redness, dark spots); retinoids (fine lines and wrinkles, acne, dark spots, large pores, oily skin); salicylic acid (acne, oily skin); vitamin C (fine lines and wrinkles, dark spots). Most consensus ingredients supported by level 1b or 2b evidence. LIMITATIONS: Some ingredients based on expert opinion. CONCLUSION: Consensus exists among expert cosmetic dermatologists regarding ingredients most useful for common dermatologic concerns
5-HT receptors: Pharmacology and functional selectivity
Get PDFSerotonin 5-HT receptors were one of the first serotonin receptors to be pharmacologically characterized. In mammals, they are expressed throughout the body in nearly every cell and tissue type, with the highest density in cortical layer V of the brain. They are involved in several aspects of normal physiological processes and behaviors and have been implicated in the etiology of neuropsychiatric diseases such as schizophrenia. Atypical antipsychotics have targeted blockade of 5-HT receptors as part of their therapeutic mechanism. More recently, 5-HT receptors have come to prominence for their role as the primary target for psychedelic drugs, which activate this receptor subtype to produce their characteristic behavioral effects. 5-HT receptor agonists like psilocybin, dimethyltryptamine, and lysergic acid diethylamide have each demonstrated long-lasting therapeutic efficacy in clinical trials for psychiatric disorders such as major depression and substance use disorders. There is a significant effort in both academia and industry to develop new agonists of 5-HT receptors with therapeutic efficacy. There are 3 primary scaffolds for agonists: tryptamines, ergolines, and phenylalkylamines, each engaging different subsets of amino acid residues in the receptor binding pocket. Differences can lead to differential responses between ligands for functionally selective outcomes. Here, we provide a historical perspective on 5-HT receptors, their key structural features and motifs involved in ligand-receptor interactions, and how these interactions can affect signaling pathways downstream of the receptor. Understanding how ligands interact with the 5-HT receptor will fundamentally inform future drug discovery to optimize therapeutics for a variety of disorders. SIGNIFICANCE STATEMENT: Psychedelic drugs have demonstrated long-lasting therapeutic efficacy for several conditions in multiple clinical trials. Their target, serotonin 5-HT receptors, are GPCRs with complex pharmacology. Having knowledge of how ligands interact with 5-HT receptors in the orthosteric binding pocket at the structural level to induce specific signal transduction pathways will inform on efforts to design and develop functionally selective drugs to potentially treat a variety of diseases
From Controller to Screen: A Narrative Review of Video Games in Medicine
No full textVideo games have become a global phenomenon in modern society as a means of entertainment, social interaction, and stress relief. Although they are often associated with negative effects, such as a lack of productivity and a sedentary lifestyle, research on video games displays potential benefits in everyday life and medical training. This narrative review provides an overview of video games and their contributions to stress relief, surgical dexterity, and cardiovascular health in the context of medical education and general wellness. To conduct this study, a comprehensive literature review search was performed utilizing PubMed and Google Scholar, placing emphasis on studies that discussed video games in society, in medicine, and in association with health. The following search terms were included: video games in medicine, video games and mental health, video games and cardiovascular health, video games and surgery, and more. Exclusion criteria for this review included papers not written in the native English language and case reports due to inherently small sample sizes. Video games show promise in relieving stress and increasing cognition, improving surgical dexterity and hand-eye coordination, and improving general cardiovascular health. They pose as a potential implementation to improve the health and wellness of medical trainees. Despite the negative societal implications of video games, there is evidence that they provide health benefits and help hone skills needed in medicine. By reducing stress, preventing long-term disease, and increasing surgical skills and dexterity, video games tap into factors from which all people, especially physicians and medical trainees, can benefit from
Caveolin-1: an ambiguous entity in breast cancer
Get PDFBreast cancer (BC) is the most frequently diagnosed cancer in women and the second leading cause of death from cancer among women. Metastasis is the major cause of BC-associated mortality. Accumulating evidence implicates Caveolin-1 (Cav-1), a structural protein of plasma membrane caveolae, in BC metastasis. Cav-1 exhibits a dual role, as both a tumor suppressor and promoter depending on the cellular context and BC subtype. This review highlights the role of Cav-1 in modulating glycolytic metabolism, tumor-stromal interactions, apoptosis, and senescence. Additionally, stromal Cav-1\u27s expression is identified as a potential prognostic marker, offering insights into its contrasting roles in tumor suppression and progression. Furthermore, Cav-1\u27s context-dependent effects are explored in BC subtypes including hormone receptor-positive, HER2-positive, and triple-negative BC (TNBC). The review further delves into the role of Cav-1 in regulating the metastatic cascade including extracellular matrix interactions, cell migration and invasion, and premetastatic niche formation. The later sections discuss the therapeutic targeting of Cav-1 by metabolic inhibitors such as betulinic acid and Cav-1 modulating compounds. While Cav-1 may be a potential biomarker and therapeutic target, its heterogeneous expression and context-specific activity necessitates further research to develop precise interventions. Future studies investigating the mechanistic role of Cav-1 in metastasis may pave the way for effective treatment of metastatic BC
Foot Drop in Orthopaedic Surgery: Anatomy, Etiology, Differential Diagnosis, and Treatment
No full text» Foot drop is a problem encountered by orthopaedic surgeons from various subspecialties. The etiology can vary from the lower extremity to the spine and can be managed conservatively depending on functional limitations. Common nonsurgical interventions include ankle-foot orthoses, physical therapy, electrical nerve stimulation, and activity modification. Surgical options vary between nerve decompression and lower extremity tendon transfers. The purpose of this review was to provide an overview of the anatomy, etiology, diagnoses, and treatment options of foot drop
Fundamentals of vascular surgery: A plan for the uniform instruction and assessment of basic skills in vascular surgery
Get PDFTraining surgeons poses many unique challenges. In addition to the clinical acumen that must be learned, a minimum threshold of technical competency is a requisite for independent practice. The trends of endovascular interventions and open surgical procedures add another layer of complexity to vascular surgery training. Simulation can provide a solution for both technical skills training and evaluating proficiency. The Education Committee of the Association of Program Directors of Vascular Surgery (APDVS) developed the Fundamentals of Vascular and Endovascular Surgery platform to provide an opportunity for more uniform basic technical skill teaching and assessment across all vascular training programs. Evaluation by experts with standardized scoring of Objective Structured Assessment of Technical Skills (OSATS) Global Rating Score and Global Summary grading systems have demonstrated correlation with participant ability when completing the end-to-side anastomosis, patch angioplasty, and clockface suturing models. Future research should be directed toward developing autonomous and objective methods for technical assessments on these models
Renal denervation improves cardiac function and exercise duration in a miniswine model of heart failure with preserved ejection fraction
Get PDFAims: Overactivity of the sympathetic nervous system is a common underlying mechanism in development and progression of several heart failure with preserved ejection fraction (HFpEF) comorbidities. Decreasing renal sympathetic nerve activity using catheter-based renal denervation (RDN) systems have shown efficacy in treating resistant hypertension and cardiac dysfunction in heart failure with reduced ejection fraction. The purpose of this study was to determine if modulation of renal sympathetic nerve activity by RDN improves cardiac function and exercise tolerance in a clinically-relevant minipig model of cardiometabolic HFpEF. Methods and results: Multiple HFpEF comorbidities were induced in adult female Göttingen minipigs by mineralocorticoid excess and a diet high in cholesterol, fat, fructose, and salt. HFpEF minipigs were randomized to bilateral catheter-RDN (n = 5) treatment or sham-RDN (n = 4). RDN therapy reduced renal sympathetic activity in HFpEF minipigs and increased treadmill exercise duration. Following RDN treatment, sustained improvements in diastolic function including E/e′ and left atrial fractional area change were observed. Elevations in resting left ventricular filling and pulmonary pressures in HFpEF minipigs, while indicative of HFpEF severity, were unaffected by RDN treatment. Following RDN treatment, there was a transient reduction in arterial blood pressure and no change in heart rate. Conclusions: Device-based RDN may be a potential therapeutic strategy to halt the progression of HFpEF by improving cardiac diastolic function and exercise tolerance
Promoting health equity through cross-sector strategies: the integration of communication public health
Get PDFCommunication is a fundamental human experience at both inter-and intrapersonal levels, deeply intertwined with societal development. Because of the integral role of communication in society, challenges in communication—whether due to differences, disorders, or environmental factors—can create significant barriers to full societal participation. Rather than viewing these challenges solely through the lens of “disability,” recognizing communication health as a distinct and essential aspect of public health is crucial for addressing these barriers and advancing health equity. This viewpoint introduces the concept of Communication Public Health, advocating for an integrated approach that unites the fields of communication sciences and disorders and public health to address communication health as a social determinant of health. It presents a conceptual framework that emphasizes collaboration across the education, employment, housing, and community sectors, highlighting the importance of perceiving communication challenges as modifiable barriers to full societal participation. It aims to offer insight and debate, and mobilize public health professionals to recognize and prioritize communication health, offering a comprehensive approach that considers both individual and societal needs. By establishing Communication Public Health as a new and distinct entity within public health infrastructure, we can better address the full spectrum of communication needs, from individuals with communication disorders and differences to those with healthy communication abilities. This perspective article format allows us to synthesize underexamined intersections between communication sciences and public health, and to advocate for an emerging framework in the absence of an established empirical evidence base