Metrics may be used to estimate optimal biopsy rates to diagnose cancer with low risk of missing tumors, thereby limiting avoidable harms and minimizing healthcare costs. The purpose of this study ...was to reduce inadvertent misunderstandings by distinguishing between 2 similar sounding statistics, number-needed-to-biopsy (NNB) and number-needed-to-diagnose (NND).
The definitions of NNB and NND were considered and compared. The relevance of each to cancer diagnosis, as well as the associated limitations, were clarified.
NNB is defined as the total number of suspicious lesions biopsied divided by the number of biopsies positive for cancer, or the inverse of absolute risk. NND represents the average number of biopsies necessary to correctly detect one person with cancer. As such, NND considers both non-biopsied cancers and controls while NNB describes an absolute risk and not a risk difference. NNB does not account for false negatives, and hence may underestimate the number of patients who need to be biopsied to identify one patient with cancer.
NNB and NND, while both relevant to the efficiency of cancer diagnosis, are defined differently and should not be used interchangeably.
Psittacine beak and feather disease virus (PBFDV) and budgerigar fledgling disease virus (BFDV) are significant avian pathogens that threaten both captive and wild birds, particularly parrots, which ...are common hosts. This study involved sampling and testing of 516 captive birds from households, pet shops, and an animal clinic in Hong Kong for PBFDV and BFDV. The results showed that PBFDV and BFDV were present in 7.17% and 0.58% of the samples, respectively. These rates were lower than those reported in most parts of Asia. Notably, the infection rates of PBFDV in pet shops were significantly higher compared to other sources, while no BFDV-positive samples were found in pet shops. Most of the positive samples came from parrots, but PBFDV was also detected in two non-parrot species, including Swinhoe’s white-eyes (
Zosterops simplex
), which had not been reported previously. The ability of PBFDV to infect both psittacine and passerine birds is concerning, especially in densely populated urban areas such as Hong Kong, where captive flocks come into close contact with wildlife. Phylogenetic analysis of the
Cap
and
Rep
genes of PBFDV revealed that the strains found in Hong Kong were closely related to those in Europe and other parts of Asia, including mainland China, Thailand, Taiwan, and Saudi Arabia. These findings indicate the presence of both viruses among captive birds in Hong Kong. We recommend implementing regular surveillance for both viruses and adopting measures to prevent contact between captive and wild birds, thereby reducing the transmission of introduced diseases to native species.
This article presents an analytical dose calculation method for high-dose-rate 192Ir brachytherapy, taking into account the effects of inhomogeneities and reduced photon backscatter near the skin. ...The adequacy of the Task Group 43 (TG-43) two-dimensional formalism for treatment planning is also assessed.
The proposed method uses material composition and density data derived from computed tomography images. The primary and scatter dose distributions for each dwell position are calculated first as if the patient is an infinite water phantom. This is done using either TG-43 or a database of Monte Carlo (MC) dose distributions. The latter can be used to account for the effects of shielding in water. Subsequently, corrections for photon attenuation, scatter, and spectral variations along medium- or low-Z inhomogeneities are made according to the radiological paths determined by ray tracing. The scatter dose is then scaled by a correction factor that depends on the distances between the point of interest, the body contour, and the source position. Dose calculations are done for phantoms with tissue and lead inserts, as well as patient plans for head-and-neck, esophagus, and MammoSite balloon breast brachytherapy treatments. Gamma indices are evaluated using a dose-difference criterion of 3% and a distance-to-agreement criterion of 2 mm. PTRAN_CT MC calculations are used as the reference dose distributions.
For the phantom with tissue and lead inserts, the percentages of the voxels of interest passing the gamma criteria (Pgamma > or = 1) are 100% for the analytical calculation and 91% for TG-43. For the breast patient plan, TG-43 overestimates the target volume receiving the prescribed dose by 4% and the dose to the hottest 0.1 cm3 of the skin by 9%, whereas the analytical and MC results agree within 0.4%. Pgamma > or = 1 are 100% and 48% for the analytical and TG-43 calculations, respectively. For the head-and-neck and esophagus patient plans, Pgamma > or = 1 are > or = 99% for both calculation methods.
A correction-based dose calculation method has been validated for HDR 192Ir brachytherapy. Its high calculation efficiency makes it feasible for use in treatment planning. Because tissue inhomogeneity effects are small and primary dose predominates in the near-source region, TG-43 is adequate for target dose estimation provided shielding and contrast solution are not used.
Injection of platelet concentrates for the treatment of aging skin has gained popularity. The objective was to systematically assess the evidence regarding the safety and effectiveness of ...platelet-rich plasma (PRP) for reducing the visible signs of aging. Cochrane Library, MEDLINE (PubMed), EMBASE, and Scopus were searched from inception to March 2019 for prospective trials and case series assessing PRP for skin aging in 10 or more patients. Twenty-four studies, including 8 randomized controlled trials (RCTs), representing 480 total patients receiving PRP, were included. Based on physician global assessment, injection PRP monotherapy was shown to at least temporarily induce modest improvement in facial skin appearance, texture, and lines. Periorbital fine lines and pigmentation may also benefit. Adjuvant PRP accelerated healing after fractional laser resurfacing. Although the degree of improvement was typically less than 50%, patients generally reported high satisfaction. It was limited by heterogeneity in PRP preparation and administration, and lack of standardization in outcome measures. PRP injections are safe and may be modestly beneficial for aging skin. The evidence is most convincing for improvement of facial skin texture. The persistence of these effects is not known. More high-quality trials with sufficient follow-up are needed to optimize treatment regimens.
Lighting is an important component of consistent, high-quality dermatologic photography. There are different types of lighting solutions available.
To evaluate currently available lighting equipment ...and methods suitable for procedural dermatology.
Overhead lighting, built-in camera flashes, external flash units, studio strobes, and light-emitting diode (LED) light panels were evaluated with regard to their utility for dermatologic surgeons. A set of ideal lighting characteristics was used to examine the capabilities and limitations of each type of lighting solution. Recommendations regarding lighting solutions and optimal usage configurations were made in terms of the context of the clinical environment and the purpose of the image.
Overhead lighting may be a convenient option for general documentation. An on-camera lighting solution using a built-in camera flash or a camera-mounted external flash unit provides portability and consistent lighting with minimal training. An off-camera lighting solution with studio strobes, external flash units, or LED light panels provides versatility and even lighting with minimal shadows and glare.
The selection of an optimal lighting solution is contingent on practical considerations and the purpose of the image.
IMPORTANCE: There remains little experimental evidence and no randomized clinical trial to date to confirm the benefit of platelet-rich plasma (PRP) for facial rejuvenation. OBJECTIVE: To investigate ...whether PRP injection improves the visual appearance, including texture and color, of photodamaged facial skin. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial, participants and raters were masked to groupings. The setting was an academic-based, urban outpatient dermatology practice in Chicago, Illinois. Participants were adults aged 18 to 70 years with bilateral cheek rhytids of Glogau class II or greater. The duration of the study was August 21, 2012, to February 16, 2016. INTERVENTIONS: Each participant received 3 mL intradermal injections of PRP to one cheek and sterile normal saline to the contralateral cheek. MAIN OUTCOMES AND MEASURES: Primary outcomes were photoaging scores (with subscores for fine lines, mottled pigmentation, roughness, and sallowness) as rated by 2 masked dermatologists. Secondary outcomes included participant self-assessment scores of improvement on a 5-point scale (worsening, no change, mild improvement, moderate improvement, or significant improvement), participant overall satisfaction scores on a 4-point scale (not satisfied, slightly satisfied, moderately satisfied, or very satisfied), and participant-reported or investigator-observed adverse events. RESULTS: Of 27 enrolled participants, 19 (mean SD age, 46.37 10.88 years; 17 female) were analyzed. Reported adverse events, which were not associated with the study agent, included redness (n = 18), swelling (n = 16), bruising (n = 14), pruritus (n = 1), skin scaling (n = 1), and dryness of skin (n = 1). No participants reported any adverse events at 12 months. Mean (SD) photoaging scores rated by 2 dermatologists showed no significant difference between PRP and normal saline for fine lines (baseline, 1.00 0.75 vs 1.05 0.78; 2 weeks, 0.95 0.71 vs 0.95 0.71; 3 months, 0.95 0.71 vs 0.95 0.71; 6 months, 0.95 0.71 vs 0.95 0.71), mottled pigmentation (baseline, 1.21 0.53 vs 1.21 0.54; 2 weeks, 1.16 0.60 vs 1.16 0.60; 3 months, 1.00 0.47 vs 1.11 0.46; 6 months, 1.16 0.69 vs 1.16 0.69), skin roughness (baseline, 0.47 0.61 vs 0.47 0.61; 2 weeks, 0.47 0.61 vs 0.47 0.61; 3 months, 0.47 0.61 vs 0.47 0.61; 6 months, 0.37 0.60 vs 0.37 0.68), and skin sallowness (baseline, 1.11 0.88 vs 1.11 0.88; 2 weeks, 0.95 0.85 vs 0.95 0.85; 3 months, 0.58 0.61 vs 0.58 0.61; 6 months, 0.37 0.68 vs 0.37 0.68). At 6 months after a single treatment, participants rated the PRP-treated side as significantly more improved compared with normal saline for texture (mean SD self-assessment score, 2.00 1.20 vs 1.21 0.54; P = .02) and wrinkles (mean SD self-assessment score, 1.74 0.99 vs 1.21 0.54; P = .03). CONCLUSIONS AND RELEVANCE: Masked participants noted that both fine and coarse texture improved significantly more with a single treatment of PRP than with normal saline. Both participants and raters found PRP to be nominally but not significantly superior to normal saline. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01372566
IntroductionWe designed and implemented a patient-centered, data-driven, holistic care model with evaluation of its impacts on clinical outcomes in patients with young-onset type 2 diabetes (T2D) for ...which there is a lack of evidence-based practice guidelines.Research design and methodsIn this 3-year Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes-Randomized Controlled Trial, we evaluate the effects of a multicomponent care model integrating use of information and communication technology (Joint Asia Diabetes Evaluation (JADE) platform), biogenetic markers and patient-reported outcome measures in patients with T2D diagnosed at ≤40 years of age and aged ≤50 years. The JADE-PRISM group received 1 year of specialist-led team-based management using treatment algorithms guided by biogenetic markers (genome-wide single-nucleotide polymorphism arrays, exome-sequencing of 34 monogenic diabetes genes, C-peptide, autoantibodies) to achieve multiple treatment goals (glycated hemoglobin (HbA1c) <6.2%, blood pressure <120/75 mm Hg, low-density lipoprotein-cholesterol <1.2 mmol/L, waist circumference <80 cm (women) or <85 cm (men)) in a diabetes center setting versus usual care (JADE-only). The primary outcome is incidence of all diabetes-related complications.ResultsIn 2020–2021, 884 patients (56.6% men, median (IQR) diabetes duration: 7 (3–12) years, current/ex-smokers: 32.5%, body mass index: 28.40±5.77 kg/m2, HbA1c: 7.52%±1.66%, insulin-treated: 27.7%) were assigned to JADE-only (n=443) or JADE-PRISM group (n=441). The profiles of the whole group included positive family history (74.7%), general obesity (51.4%), central obesity (79.2%), hypertension (66.7%), dyslipidemia (76.4%), albuminuria (35.4%), estimated glomerular filtration rate <60 mL/min/1.73 m2 (4.0%), retinopathy (13.8%), atherosclerotic cardiovascular disease (5.2%), cancer (3.1%), emotional distress (26%–38%) and suboptimal adherence (54%) with 5-item EuroQol for Quality of Life index of 0.88 (0.87–0.96). Overall, 13.7% attained ≥3 metabolic targets defined in secondary outcomes. In the JADE-PRISM group, 4.5% had pathogenic/likely pathogenic variants of monogenic diabetes genes; 5% had autoantibodies and 8.4% had fasting C-peptide <0.2 nmol/L. Other significant events included low/large birth weight (33.4%), childhood obesity (50.7%), mental illness (10.3%) and previous suicide attempts (3.6%). Among the women, 17.3% had polycystic ovary syndrome, 44.8% required insulin treatment during pregnancy and 17.3% experienced adverse pregnancy outcomes.ConclusionsYoung-onset diabetes is characterized by complex etiologies with comorbidities including mental illness and lifecourse events.Trial registration numberNCT04049149.
Patients presenting for cosmetic dermatology procedures are often interested in lifestyle enhancement rather than treatment of an inflammatory or neoplastic disease or condition. In addition to good ...clinical outcomes, they may also particularly value the quality of the patient experience in the dermatology office. A list of beneficial practices that may improve patient experience was generated by interviewing staff members from several US practices, including clinic administrators, nurses, nurse managers, medical assistants, physician assistants, patient care coordinators, and dermatologists. Each was asked ten open-ended questions. The list of beneficial practices thereby obtained was ordered based on the number of participants who recommended each practice. Practices were further categorized into four categories: clinician improvement, administrative improvement, clinic improvement, and team improvement. For clinics providing cosmetic dermatology services, certain well-accepted beneficial practices may improve patient experience.
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