A comprehensive understanding of neuroprotective pathways is essential to progress in the battle against numerous neurodegenerative conditions. The hypothalamic suprachiasmatic nucleus (SCN) is ...endogenously resistant to glutamate (Glu) excitotoxicity in vivo. This study was designed to determine whether immortalized SCN neurons (SCN2.2 cells) retain this characteristic. We first established that SCN2.2 cells retained the ability to respond to Glu. SCN2.2 cells expressed N-methyl-d-aspartate (NMDA) receptor subtypes NR1 and NR2A/2B, suggesting the presence of functional receptors. mRNA for the NMDA receptor subunits NR2A and NR2B were higher in the SCN2.2 than in the control hypothalamic neurons (GT1-7). Specific NMDA receptor antagonists (+)-5-methyl-10,11-dihydro-5H-dibenzoa,dcyclohepten-5,10-imine maleate and d-(-)-2-amino-5-phosphonovaleric acid blocked Glu-induced activation of gene expression. SCN2.2 cells were resistant to Glu excitotoxicity compared with GT1-7 neurons as assessed with a mitochondrial function assay, cell death by trypan blue exclusion and apoptosis by terminal deoxynucleotidyl transferase dUTP nick end labeling. SCN2.2 resistance to Glu excitoxicity was retained in the presence of the broad spectrum Glu transport inhibitor, l-trans-pyrrolidine-2,4 dicarboxylate, excluding glial Glu uptake as a major neuroprotective mechanism. Collectively, these observations demonstrate endogenous neuroprotection in SCN2.2 cells; this cell line is resistant to excitotoxicity under conditions that are toxic to other immortalized cell lines. Thus, the SCN2.2 cell line may provide insights into the molecular mechanisms that confer endogenous neuroprotection in the SCN.
BACKGROUNDThe type of cosmetic dermatologic procedures patientsʼ desire may be influenced by demographic factors.
OBJECTIVETo better understand the type of cosmetic procedures requested by patients ...of different age, gender, education, race, and geographic location. To understand the most common motivations of patients who requested particular types of treatments.
MATERIALS AND METHODSMulticenter data from the Cosmetic Motivation Database were analyzed. Bivariable analyses and linear regressions were undertaken to determine whether patient demographic features were associated with particular procedures of interest.
RESULTSPatients younger than 45 years were more interested in acne scar treatment, laser hair removal, liposuction, and tattoo removal. Older patients were more likely to want soft-tissue fillers and wrinkles and jowls tightening treatment. Non-White patients were more likely to be interested in laser hair removal, liposuction, cellulite treatment, and tattoo removal. Types of procedures desired varied by the geographic region but not by the educational level. Different motivations drove patients who wanted different types of treatments.
CONCLUSIONDifferent types of patients demand different types of cosmetic treatments, and the motivations of patients who ask for particular procedures also differ. Better understanding of patient preferences may help physicians allocate resources and meet patient needs.
To describe our experience with a novel technique for total skin irradiation using helical TomoTherapy (Accuray, Sunnyvale, CA).
An infant with refractory acute myelogenous leukemia with extensive ...cutaneous involvement was given total skin irradiation using inverse-planned helical tomotherapy. Quality assurance tests to determine the deliverability of the technique and the accuracy of dose estimation at the superficial skin level were devised and performed. Daily megavoltage imaging, tomotherapy plan adaptive evaluation, in vivo skin dose measurements, and cumulative dose summation were tools employed to assess the quality of treatment and positioning reproducibility on a daily basis.
The quality assurance checks showed that tomotherapy can indeed be used for total skin irradiation in cases where conventional electron treatment delivery is not possible. However, the overestimation of absorbed dose near surface by the treatment planning software must be quantified and taken into account using in-phantom and in vivo dosimetry techniques with appropriate detectors. Daily imaging allows for superior positioning, while daily plan adaptive and dose summations based on the plan adaptive calculations allow for evaluation of the treatment delivery.
An infant has been treated successfully using helical TomoTherapy for total skin irradiation prior to allogeneic stem cell transplant. The course of treatment was uncomplicated and the patient is doing well more than 15 months following therapy.
AbstractObjectiveTo evaluate the evidence upon which standards for hospital accreditation by The Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission) are ...based.DesignCross sectional study.SettingUnited States.ParticipantsFour Joint Commission R3 (requirement, rationale, and reference) reports released by July 2018 and intended to become effective between 1 July 2018 and 1 July 2019.InterventionsFrom each R3 report the associated standard and its specific elements of performance (or actionable standards) were extracted. If an actionable standard enumerated multiple requirements, these were separated into distinct components. Two investigators reviewed full text references, and each actionable standard was classified as either completely supported, partly supported, or not supported; Oxford evidence quality ratings were assigned; and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the strength of recommendations.Main outcome measureStrengths of recommendation for actionable standards.Results20 actionable standards with 76 distinct components were accompanied by 48 references. Of the 20 actionable standards, six (30%) were completely supported by cited references, six were partly supported (30%), and eight (40%) were not supported. Of the six directly supported actionable standards, one (17%) cited at least one reference of level 1 or 2 evidence, none cited at least one reference of level 3 evidence, and five (83%) cited references of level 4 or 5 evidence. Of the completely supported actionable standards, strength of recommendation in five was deemed GRADE D and in one was GRADE B.ConclusionsIn general, recent actionable standards issued by The Joint Commission are seldom supported by high quality data referenced within the issuing documents. The Joint Commission might consider being more transparent about the quality of evidence and underlying rationale supporting each of its recommendations, including clarifying when and why in certain instances it determines that lower level evidence is sufficient.
The extent to which demographics drive patients to pursue minimally invasive cosmetic procedures is not well-understood. The aim of this project was to better understand how patient demographics ...impact motivations for cosmetic procedures, irrespective of the procedure desired. Patient-level information from the Cosmetic Motivation Database was evaluated using linear regression analyses to determine whether geographic region, age, gender, race, and education independently influence patients to pursue any cosmetic treatment or consultation. Patients in the Midwest reported fewer motivations related to cosmetic appearance, mental/emotional health, physical health, social life, and school/work success than those in the South. Patients younger than 45 years reported more mental/emotional health and cost/convenience motives compared to older patients. Men noted fewer motives related to cosmetic appearance, mental/emotional health, and cost/convenience but more related to school/work success. Non-White patients reported more cost/convenience motives. Participants with up to a high school diploma cited more mental/emotional health, physical health, social life, and school/work success motivations than those with post-bachelor’s education. College graduates cited more school/work success motives than those with graduate-level education. In summary, patient’s gender, education, age, location, and race affect why they seek cosmetic treatments. Future research may study younger and less educated patients to improve their access to treatment.
This article introduces a scatter correction (SC) technique for high-dose-rate (HDR)
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brachytherapy dose calculations in the absence of a full scatter environment near the skin. The technique ...uses dosimetry data derived by Monte Carlo (MC) simulations for the Nucletron microSelectron v2 HDR
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source. The data include the primary and scatter components of the radial dose function and the anisotropy function in addition to a SC table. The dose to a point of interest for each dwell position is estimated by first calculating the primary and scatter doses in an infinite water phantom. The scatter dose is then scaled by a SC factor that depends on the distances between the point of interest, the dwell positions, and the body contour of the patient. SC calculations in water phantoms of three different shapes, as well as computed tomography-based geometries of 18 multicatheter breast patients, are compared with Task Group 43 (TG-43) and PTRAN_CT MC calculations. The SC calculations show improvement over TG-43 for all test cases while taking 50% longer to run. The target and skin doses for the breast patient plans are unaffected by tissue inhomogeneities, as indicated by an agreement better than 1% between the SC and MC results. On average, TG-43 overestimates the target coverage by 2% and the dose to the hottest
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of the skin by 5%. The low-density lung causes the lung and heart
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to differ by up to 3% for the SC method and by 2%–5% for TG-43 compared with MC calculations. The SC technique is suitable for HDR
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dose calculations near the skin provided that the dose is nearly unperturbed by internal inhomogeneities. It has been validated for multicatheter breast brachytherapy.
Global declines in shorebird populations resulting from foraging habitat loss have been recently reported, and the situation within the East Asian‐Australasian Flyway (EAAF) is particularly ...concerning. Despite previous studies that analyzed the foraging niches of shorebirds worldwide, the dietary niche dynamics of shorebirds coexisting in Asia are very poorly understood. This study is therefore among the early few that aim to unveil the trophic organization of shorebirds in a subtropical wetland within the EAAF which is vital for species conservation. Our study first determined the dietary spectra of more than 10 shorebird species, such as Calidris ferruginea (near threatened), Charadrius leschenaultii, and Pluvialis squatarola, by applying DNA metabarcoding with 18S and COI markers to fecal DNA. The diet of Tringa stagnatilis was also characterized, which was previously undescribed. Shorebirds that occurred in the wetland consumed a variety of food items, primarily a high abundance of malacostracans, mollusks, annelids, insects, and some arachnids. Different proportions of plant materials were also detected in many shorebird species. Using the data, we then revealed clear patterns of inter‐ and intraspecific variations between these shorebirds. Importantly, we specifically compared the similarities of the spring diets among seven sympatric shorebird species. We found that the dietary compositions of the seven species have segregated from each other to varying levels, but the many similar taxa we identified in the diets among these shorebirds imply that these populations of shorebirds could be competing at different levels. Thus, any reductions in the abundance and diversity of these important food resources would likely intensify their inter‐ and intraspecific competition, and simultaneously threaten the survival of multiple species. With these findings, conservation measures must be taken to protect and monitor the vital food resources for these energy‐deprived shorebirds during migration.
Despite previous studies that analyzed the foraging niches of shorebirds worldwide, the dietary niche dynamics of shorebirds coexisting in Asia are very poorly known. This study is therefore the early few that aim to unveil the trophic organization of shorebirds in a subtropical wetland within the EAAF. Our study determined the dietary spectra of more than 10 shorebird species by applying DNA metabarcoding on fecal DNA. Using the data, we revealed clear patterns of the interspecific and intraspecific variations between these shorebirds. We also specifically compared the similarities of the spring diets between seven sympatric shorebirds species. The understanding on their dietary niche dynamics is vital for species conservation.
IMPORTANCE Surgical training in dermatology residencies has increased, and there is growing interest in measuring resident competence more precisely. This study applies the use of the objective ...structured assessment of technical skills (OSATS) to measure competence in dermatologic surgery. OBJECTIVE To evaluate the utility of OSATS as a tool for measuring surgery skills during dermatology residency training. DESIGN, SETTING, AND PARTICIPANTS Multirater, blinded review and ratings of taped video recordings of elliptical excisions performed by senior dermatology residents applying for procedural or Mohs surgery fellowships. MAIN OUTCOMES AND MEASURES Ratings on a specific OSATS measure, including global rating scale and task checklist. RESULTS Twelve videos, representing approximately 20% of fellowship applicants during 2009-2010, were rated. Raters agreed on 272 of 288 subscore ratings (94.4%). Mean global ratings were 4 or 5 for all categories, except time and motion, which had a rating of 3. Task checklist ratings had a mean of 14.5 and a mode of 16 (perfect score), with eversion least often performed successfully. No association was found between a resident's scores and the number of surgical rotation months or between scores and the number of Mohs surgeons at the home institution. CONCLUSIONS AND RELEVANCE Senior dermatology residents preparing for surgery fellowships are highly skilled in performing elliptical excisions and bilayered repairs. The OSATS appears useful and reliable for the evaluation of dermatologic surgery skills.
IMPORTANCE: Soft-tissue augmentation with skin fillers can be delivered with needles or microcannulas, but unwanted vascular occlusions are possible. OBJECTIVE: To determine whether filler-associated ...vascular occlusion events of the face occur more often with injections performed with needles than with microcannulas. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a random sample of board-certified dermatologists deemed eligible based on membership in relevant professional societies and attendance at relevant national professional meetings. Participants completed detailed forms in which they could enter deidentified data and volume statistics pertaining to patients undergoing filler procedures in their practices. Data were collected from August 2018 to August 2019. EXPOSURES: Injectable fillers approved by the US Food and Drug Administration delivered via needles or microcannulas. MAIN OUTCOMES AND MEASURES: The primary outcome measure was intravascular occlusion. Occlusion events were graded by severity (no sequelae, scar, and ocular injury or blindness). RESULTS: A total of 370 dermatologists (mean SD years in practice, 22.3 11.1 years) participated and reported 1.7 million syringes injected. The risk of occlusion with any particular filler type using needle or cannula never exceeded 1 per 5000 syringes injected. Overall, 1 occlusion per 6410 per 1-mL syringe injections was observed with needles and 1 per 40 882 with cannulas (P < .001). Of the 370 participants, 106 (28.6%) reported at least 1 occlusion. Multivariate analysis found that injections with cannula had 77.1% lower odds of occlusion compared with needle injections. Participants injecting fillers for more than 5 years had 70.7% lower odds of occlusion than those who were less experienced. For each additional injection per week, the odds of occlusion decreased by 1%, and 85% of occlusions had no long-term sequelae. Nasolabial folds and lips were most likely to be occluded, with mean severity level of occlusions highest at the glabella. CONCLUSIONS AND RELEVANCE: In this cohort study, filler injections with either needles or cannulas were associated with a very low risk of intravascular occlusion events. Moreover, the vast majority of such events were minor and resolved without scar or other injury. Injections with microcannulas were less often associated with occlusion events than injections with needles. Occlusion risk per syringe appeared decreased after the first few years of clinical practice and was also lower among those who more frequently inject fillers. Whether a needle or cannula is most appropriate for injection may depend on patient factors, anatomic site, and the type of defect being treated.
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