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The field of cosmetic dermatology has been transformed by the integration of Artificial Intelligence (AI) technologies, which have improved the precision and efficacy of cosmetic procedures and opened up new possibilities for personalized skincare. AI algorithms can accurately analyze and diagnose skin conditions, leading to objective diagnoses and customized treatment plans. AI also allows for the prediction of treatment outcomes and virtual consultations, enhancing patient-doctor confidence and convenience. However, it is important to address ethical concerns, such as privacy protection and the fair distribution of AI technology. Overall, the future of AI in cosmetic dermatology holds great promise for practitioners and patients, improving diagnostic accuracy and patient outcomes. [Extracted from the article]

Background: Cryolipolysis has revolutionized the field of cosmetic dermatology as a nonsurgical procedure, utilizing controlled cooling to selectively destroy fat cells. Aims and methods: This review article will focus on the future prospects of cryolipolysis, considering advancements in current technology as well as innovations that hold promise for the future. We will explore emerging trends in cryolipolysis, considering novel applicator designs, combination therapies, an innovative injectable treatment approach, and the evolving role of this technology in the field of cosmetic dermatology. Conclusion: The future holds promise for advances in cryolipolysis using both the noninvasive topical cooling approach and the novel injectable ice‐slurry technology. [ABSTRACT FROM AUTHOR]

Objectives: There is growing evidence that excess adipose tissue within the head and neck contributes to obstructive sleep apnea (OSA), particularly in obese patients. This subset of the population is often difficult to treat with surgical therapies. We theorized that a novel, transcervical method of injectable cryoablation using ice‐slurry can achieve low temperatures without causing neurovascular damage or airway distress in a swine model. Methods: Four Yorkshire pigs were injected with ice‐slurry comprised of normal saline and 10% glycerol cooled to −6°C via a transcervical, ultrasound guided approach. Direct laryngoscopy was used to confirm accurate placement of the slurry. Thermocouple placement at the needle‐tip was used to measure temperatures at injection site. Swine were monitored for clinical signs of tongue necrosis and airway edema for 2 months, and then euthanized. Twelve biopsy samples from the base of the tongue were collected for histology. These were assessed for presence of tissue damage, inflammation and collagen formation by a blinded board‐certified pathologist. Results: Tongue tissue temperature below 10°C was achieved for 13.5 ± 1.1 min. Minimum tissue temperature was −4 ± 0.6°C. There was no clinical or pathological evidence of tongue damage to include damage to the lingual nerve or artery. There was some histologic evidence of new collagen formation in areas of the tongue. Conclusions: Transcervical ultrasound‐guided ice‐slurry injection is feasible, well‐tolerated at temperatures previously shown to be capable of selectively targeting adipose tissue in the base of the tongue in a preclinical swine model, without causing neurovascular damage or airway distress when properly injected. [ABSTRACT FROM AUTHOR]

Background: Cryoneurolysis uses tissue cooling as an opioid-sparing, long-lasting treatment for peripheral nerve pain. A nerve-selective method for cryoneurolysis by local injection of ice-slurry was developed to allow cryoneurolysis to be performed with a standard needle and syringe, similar to peripheral nerve blocks. Since the treatment of patients with chronic pain may require repeated injections, we investigated the safety and tolerance of repeated treatments in a rat model. Methods: Three repeated ice-slurry treatments, given 6 weeks apart were performed around the rat sciatic nerve. Nerve and surrounding tissues were collected up to 4 months after the third treatment for analysis. Coherent anti-Stokes Raman scattering (CARS) microscopy was used to study effects on myelin sheaths and axon structure. Immunofluorescence (IF) staining was used to study effects on axon density. Hematoxylin and Eosin (H&E) staining was used to examine histologic effects on sciatic nerve and surrounding tissue. Results: Histologic and CARS image analysis of nerve tissue collected months after three injections demonstrated recovery of nerve structure, myelin organization and axon density to baseline levels, without any residual inflammation, scarring or neuroma formation. No inflammation or scarring was detected in surrounding skin and muscle tissues. Conclusion: Repeated ice-slurry injections cause temporary, nerve-selective and reversible changes in the peripheral nerve. There was no histologic damage to surrounding skin and muscle tissues. Repeated treatments with injectable ice-slurry for cryoneurolysis appear to be safe and well tolerated. Clinical studies for patients with chronic pain are warranted. [ABSTRACT FROM AUTHOR]

Medical innovation is crucial to advancing our field, and physicians have the potential to play a leading role due to their daily patient care experiences. The objective of this study was to evaluate the interest in, and barriers to participating in innovation. Two surveys were conducted; the first cross-sectional survey was conducted among attendees of the Advancing Innovation in Dermatology Forum in Feburary 2019. The second survey was conducted among trainees (resident/fellows) and faculty dermatologists at Brown, Emory, Iowa, Stanford, and Vanderbilt Universities between June and November 2019. Demographic data were collected, as well as factors involved with identifying problems, developing solutions, training in innovation, and perceived barriers to innovation. In the first survey, the greatest perceived benefits include bringing joy to one's work and increasing professional fulfillment with work. Innovation was also perceived to decrease burnout. In the second survey of academic centers, faculty more commonly expressed interest in identifying problems (p = 0.04), and was also more confident in their ability to generate solutions to these problems as compared to trainees (p < 0.01). Major barriers to participating in innovation processes included lack of time and lack of training or education in innovation. Both trainees and faculty groups noted a lack of knowledge in creating prototypes, understanding regulatory approval for medical products, and inexperience with pitching to investors or obtaining funding. These cross-sectional needs assessment surveys found a strong interest in innovation coupled with a lack of education in innovation processes. These findings suggest an urgent need and opportunity for providing formal training to empower dermatologists with the tools to lead innovation within our field. [ABSTRACT FROM AUTHOR]

Clinicians play a critical role in recognizing, initiating, and adopting innovative solutions to clinical problems. Increasing clinician involvement in problem-based innovation will help identify and solve unmet medical needs. The overall objective of our program was to increase clinician involvement in problem-based innovation. We pioneered and piloted the "Magic Wand" Initiative (MWI) at Massachusetts General Hospital Department of Dermatology, by inviting clinical faculty to voluntarily participate in problem-driven innovation. The primary outcome was the number of unmet clinical needs identified and pursued by clinicians, who were 'activated' to initiate problem-based innovation. Other objectives were to enhance clinician-to-clinician dialogue and to develop specific strategic framework for clinician-led, problem-driven research. This pilot MWI was started in 2013 with an announcement at dermatology faculty meeting inviting all clinical faculty to participate on volunteer basis. Academic dermatologists were the main participants in this program. They also contacted, collaborated and worked with research faculty, industry experts and lawyers. Out of 30 unmet needs identified by clinicians participating in MWI, eight are actively being pursued by clinicians. Three of those cases presented here have achieved publications, grant funding, prototype devices and product for patient use. In conclusion, MWI is an innovative approach that educates and equips clinician to identify and solve problems and engages them as leaders in their healthcare ecosystem. MWI has achieved concrete measurable success, affirming that if clinicians are empowered and supported to identify and solve existing unmet medical problems, new and innovative solutions can be invented to improve patient care. [ABSTRACT FROM AUTHOR]

Patient-centered and physician-led innovations are key to promoting physicians as visionary leaders in the healthcare system especially during times of crises. COVID-19 has inspired some promising recent advancements within medicine worth noting, including improvements in telemedicine, 3-D printed personal protective equipment (PPE) and ventilators, drug and vaccine development, sterilization of PPE allowing for reuse, and point of care testing; they highlight a broader lesson for how we might innovate better within medicine, even after the crisis has passed. As such, with the complexities of modern-day medicine, to continue to foster this culture of innovation, it is paramount that going forward, medical education adapt and embrace an innovation curriculum that prepares physicians and healthcare workers to work with their communities and researchers to confidently tackle any challenges that may present. Integrating innovation into our careers and medical training is important for advancement of the field and to be able to handle challenges that may present to the healthcare system. [ABSTRACT FROM AUTHOR]

Purpose: Increased neck circumference is a major risk factor for obstructive sleep apnea (OSA). New data suggest that increased adipose tissue in the neck may be a contributory cause of OSA. The aim of this study was to investigate safety and efficacy of a recently developed injectable ice slurry in selective reduction of neck adipose tissue in a mouse model. Methods: We used the New Zealand obese mice that have increased volume of anterior neck fat, and are commonly used in OSA studies. MRI imaging was used to measure changes in fat tissue volume. Results: Thirty animals were used in this study. Volumetric measurements in MRI images showed thatchanges in anterior neck adipose tissue volume from baseline in treated mice was significantly different in comparison with the control group (−1.09/kg ± 0.33/kg vs 0.68/kg ± 0.37/kg; p < 0.01 by two-tailed Student's t test). Histological analysis of samples from the treated area of the neck did not show scarring or damage to the surrounding tissues. Conclusions: Injection of ice slurry safely, effectively, and selectively reduces upper airway fat in New Zealand obese mice without scarring or damage to surrounding tissue. Our results suggest that slurry injection may be a novel and minimally invasive method of removing neck adipose tissue. This intervention should be further investigated to determine its suitability for treatment of OSA. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain caused by trauma to nerves and tissue around the surgical site is a major problem. Perioperative steps to reduce postoperative pain include local anesthetics and opioids, the latter of which are addictive and have contributed to the opioid epidemic. Cryoneurolysis is a nonopioid and long-lasting treatment for reducing postoperative pain. However, current methods of cryoneurolysis are invasive, technically demanding, and are not tissue-selective. This project aims to determine whether ice slurry can be used as a novel, injectable, drug-free, and tissue-selective method of cryoneurolysis and resulting analgesia.Methods: The authors developed an injectable and selective method of cryoneurolysis using biocompatible ice slurry, using rat sciatic nerve to investigate the effect of slurry injection on the structure and function of the nerve. Sixty-two naïve, male Sprague-Dawley rats were used in this study. Advanced Coherent anti-Stokes Raman Scattering microscopy, light, and fluorescent microscopy imaging were used at baseline and at various time points after treatment for evaluation and quantification of myelin sheath and axon structural integrity. Validated motor and sensory testing were used for evaluating the sciatic nerve function in response to ice slurry treatment.Results: Ice slurry injection can selectively target the rat sciatic nerve. Being injectable, it can infiltrate around the nerve. The authors demonstrate that a single injection is safe and selective for reversibly disrupting the myelin sheaths and axon density, with complete structural recovery by day 112. This leads to decreased nocifensive function for up to 60 days, with complete recovery by day 112. There was up to median [interquartile range]: 68% [60 to 94%] reduction in mechanical pain response after treatment.Conclusions: Ice slurry injection selectively targets the rat sciatic nerve, causing no damage to surrounding tissue. Injection of ice slurry around the rat sciatic nerve induced decreased nociceptive response from the baseline through neural selective cryoneurolysis. [ABSTRACT FROM AUTHOR]

Hair loss is both a common chief complaint by patients and a clinical challenge for physicians, especially general practitioners, yet few dermatological problems yield as much patient satisfaction when resolved as hair loss. The diagnosis is often attributed to androgen-related hair loss, while other causes, some of which are life-threatening but treatable, are overlooked. We searched for relevant literature on hair loss and supported these findings with our clinical experience to identify seven major systemic etiologies of hair loss, ranging from infectious agents to consumption of unsafe supplements. Many causes are only described in the literature through case studies, though some original articles and meta-analyses are available. Careful history taking, proper examination techniques, and judicious use of laboratory tests are essential to reach at the correct diagnosis in a cost-effective manner when performing patient work-up. Such methodical evaluation of hair loss can result in the appropriate treatment plan and provide significant patient satisfaction. Key messagesHair loss is a common chief complaint and a difficult challenge for both general practitioners and dermatology consultants.We identified seven major categories of systemic hair loss etiology and present a framework for their clinical evaluation.A methodical approach to hair loss can result in the appropriate treatment plan and provide significant patient satisfaction. [ABSTRACT FROM PUBLISHER]

Purpose: The objective of this study was to evaluate the palliative treatment benefit of surface-mold computer-optimized high-dose-rate brachytherapy (SMBT) for in-transit cutaneous metastases of Merkel cell carcinoma (MCC).Methods: Ten patients with in-transit cutaneous MCC metastases were treated with SMBT at the Dana-Farber/Brigham & Women's Cancer Center between 2006 and 2012.Results: The median age at diagnosis was 76 years (range, 63-87 years). Seven patients had in-transit metastases on the lower extremities (70%), 2 patients on the head and neck (20%), and 1 patient on an upper extremity (10%). A total of 152 metastatic MCC lesions were treated with SMBT. All SMBT-treated lesions resolved clinically within a few weeks of therapy. The median follow-up was 34 months (range, 22-85 months). Two of 152 treated lesions recurred during the study period for a local control rate of 99%. Eight patients (80%) developed additional in-transit metastases outside the original SMBT fields. Five of these 8 patients underwent additional SMBT. At study conclusion, 3 patients (30%) are alive without disease, 3 patients (30%) are alive with disease, and 4 patients (40%) died of MCC.Discussion: Surface-mold computer-optimized high-dose-rate brachytherapy offers effective and durable palliation for cutaneous metastases of MCC, although it does not appear to alter disease course. [ABSTRACT FROM AUTHOR]

The incidence of melanoma has continued to rise dramatically over the past few decades, especially in young females. Due to the deadly nature of this disease, melanoma has become an important public health problem. It is generally accepted that ultraviolet light radiation (UVR) from sunlight is a major risk factor for melanoma skin cancer development. However, the mechanistic details of how sunlight via UVR causes melanoma are still being elucidated. Currently, it is thought that carcinogenic, inflammatory, and immunosuppressive properties of UVR all contribute to initiation, progression, and metastasis of primary melanoma. We review current findings on how sunlight-generated UVR generates DNA damage, inflammation, and immune suppression, thus leading to melanoma. [ABSTRACT FROM AUTHOR]

B cells from patients with common variable immunodeficiency (CVID) who are heterozygous for transmembrane activator and CAML interactor (TACI) mutation C104R, which abolishes ligand binding, fail to produce Igs in response to TACI ligand. It is not known whether this is due to haploinsufficiency or dominant interference. Using in vitro transfection assays, here we demonstrate that C104R and the corresponding murine TACI mutant, C76R, which also does not bind ligand, dominantly interfere with TACI signaling. This effect was dependent on preassociation of the mutants with WT TACI in the absence of ligand. The mutants did not interfere with ligand binding by WT TACI, suggesting that they may act by disrupting ligand-induced receptor rearrangement and signaling. This work demonstrates that TACI preassembles as an oligomeric complex prior to ligand binding and provides a mechanistic insight into how the heterozygous C104R TACI mutation can potentially lead to CVID. [ABSTRACT FROM AUTHOR]

The tumor necrosis factor receptor family member TACI (transmembrane activator and calcium-modulator and cyclophilin ligand interactor) mediates isotype switching in B cells. We found that 4 of 19 unrelated individuals with common variable immunodeficiency (CVID) and 1 of 16 individuals with IgA deficiency (IgAD) had a missense mutation in one allele of TNFRSF13B (encoding TACI). One of the four individuals with CVID had a single nucleotide insertion in the other TNFRSF13B allele. None of these mutations were present in 50 healthy subjects. TNFRSF13B mutations cosegregated with the phenotype of CVID or IgAD in family members of four index individuals that we studied. B cells from individuals with TACI mutations expressed TACI but did not produce IgG and IgA in response to the TACI ligand APRIL, probably reflecting impaired isotype switching. These results suggest that TACI mutations can result in CVID and IgAD. [ABSTRACT FROM AUTHOR]

Onychomycosis is a challenging nail condition to treat. The gold standard treatment relies on long-term systemic therapy, which carries risks of potential side effects and drug interactions. Topical alternatives exist; however, treatment outcomes remain disappointing. In this article, we review newer topical formulations that are approved by the United States Food and Drug Administration, as well as other topical drugs that are still undergoing clinical trials. Lasers and energy-based devices have also been used for the treatment of onychomycosis; however, standardized parameters and clear treatment endpoints have yet to be specified. Currently, device-based therapies are considered as options for improving the cosmetic appearance of nails. The use of lasers to improve the penetration of topical antifungal treatments as possible combination treatments is also reviewed. [ABSTRACT FROM AUTHOR]

We have applied a genetic system for analyzing mutations in Escherichia coli to Deinococcus radiodurans, an extremeophile with an astonishingly high resistance to UV- and ionizing-radiation-induced mutagenesis. Taking advantage of the conservation of the β-subunit of RNA polymerase among most prokaryotes, we derived again in D. radiodurans the rpoB/Rifr system that we developed in E. coli to monitor base substitutions, defining 33 base change substitutions at 22 different base pairs. We sequenced >250 mutations leading to Rifr in D. radiodurans derived spontaneously in wild-type and uvrD (mismatch-repair-deficient) backgrounds and after treatment with N-methyl-N′-nitro-N-nitrosoguanidine (NTG) and 5-azacytidine (5AZ). The specificities of NTG and 5AZ in D. radiodurans are the same as those found for E. coli and other organisms. There are prominent base substitution hotspots in rpoB in both D. radiodurans and E. coli. In several cases these are at different points in each organism, even though the DNA sequences surrounding the hotspots and their corresponding sites are very similar in both D. radiodurans and E. coli. In one case the hotspots occur at the same site in both organisms. [ABSTRACT FROM AUTHOR]