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Food deserts exist due to a multitude of factors ranging from socioeconomic status, racial disparities, geography, cost, and healthful food access. Given the vast biological function of vitamins and minerals, the clinical presentation for nutritional deficiencies ranges from benign to life-threatening. Often, the first indicators of underlying nutritional deficiencies are cutaneous manifestations. The first patient case is a 36-year-old female at 25 weeks gestation with a pruritic and painful rash that began in the genital region and spread centrifugally to her legs. The second patient case is a 42-year-old male with a pruritic rash that began at his abdomen and progressed to his thighs. The third patient case is a 48-year-old female with scattered lower extremity ecchymoses in different healing stages and scattered perifollicular erythema with corkscrew hairs. All three patients were found to have nutritional deficiencies and lived in identified food deserts. Deficiencies of zinc, vitamin A, thiamine, pyridoxine, and vitamin C and their subsequent cutaneous manifestations have scarce documentation within food deserts. These cases provide further insight into nutritional deficiencies and offer an opportunity for providers to identify patients at risk. To promote wellness, patients suffering from food insecurity must be identified efficiently and connected with essential resources., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Canakis et al.)

H 2 S is a toxic and corrosive gas, whose accurate detection at sub-ppm concentrations is of high practical importance in environmental, industrial, and health safety applications. Herein, we propose a chemiresistive sensor device that applies a composite of single-walled carbon nanotubes (SWCNTs) and brominated fullerene (C 60 Br 24 ) as a sensing component, which is capable of detecting 50 ppb H 2 S even at room temperature with an excellent response of 1.75% in a selective manner. In contrast, a poor gas response of pristine C 60 -based composites was found in control measurements. The experimental results are complemented by density functional theory calculations showing that C 60 Br 24 in contact with SWCNTs induces localized hole doping in the nanotubes, which is increased further when H 2 S adsorbs on C 60 Br 24 but decreases in the regions, where direct adsorption of H 2 S on the nanotubes takes place due to electron doping from the analyte. Accordingly, the heterogeneous chemical environment in the composite results in spatial fluctuations of hole density upon gas adsorption, hence influencing carrier transport and thus giving rise to chemiresistive sensing.

Objective: Review the pathogenesis of recessive dystrophic epidermolysis bullosa and provide an update on research currently underway that is aimed at treating and potentially curing this severe skin disorder., Design: Review article., Setting: Private practice and large teaching hospital., Participants: None., Measurements: N/A., Results: Currently, patients with recessive dystrophic epidermolysis bullosa are managed with only supportive care. However, there are several promising new treatment avenues that may help patients in the future. These include gene therapy, cell therapy, and protein-based therapy. Each approach offers distinct advantages and disadvantages., Conclusions: The advances in understanding the molecular basis for epidermolysis bullosa over the last few decades has led to significant progress in devising new treatment options. Though many of these approaches remain several years away from regular implementation, it is an exciting time for research in the field.

Background: There are various surgical techniques used treat anal fistulas. The adoption and success rates of newer techniques have not been clearly established., Objective: The purpose of this study was to determine the healing rate after operations for anal fistulas in New England colorectal surgery practices., Design: We conducted a retrospective review of a prospectively collected database., Settings: The study was conducted at colorectal surgery practices in New England., Patients: A prospective, multicenter registry was created by the New England Society of Colon and Rectal Surgeons. Surgeons were invited to collect data prospectively regarding patients operated on for anal fistulas between January 1, 2011, and August 1, 2013. Fistula classification, surgical intervention, continence scores, and healing were determined by the treating surgeon., Intervention: Operation for anal fistula was performed., Main Outcome Measures: We measured the proportion of patients with healed fistulas at 3 months., Results: Sixteen surgeons submitted data regarding 240 operations for fistula with curative intent. Mean patient age was 45 ± 14 years. A total of 158 patients (66%) were men, and 110 (46%) had undergone an anorectal operation. Twenty-nine (12%) had Crohn's disease. The healing rates of fistulotomy, advancement flap, and fistula plugs at 3 months were 94% (95% CI, 89-97), 60% (95% CI, 33-77), and 20% (95% CI, 5-50). The healing rate of the ligation of intersphincteric fistula tract procedure at 3 months was 79% (95% CI, 65-88). Hospital site was the only variable associated with healing (p < 0.05). Hospitals that performed more ligation of intersphincteric fistula tract procedures had higher healing rates at 3 months (p < 0.0001)., Limitations: This study was limited by selection bias and reporting bias., Conclusions: A wide variety of techniques are used to treat anal fistulas in our region. Fistulotomy continues to have excellent results. There has been enthusiastic early adoption of the ligation of intersphincteric fistula tract technique. Early healing rates after the ligation of intersphincteric fistula tract procedure appear to be excellent.

Background: Injectable poly-L-lactic acid (PLLA) is a biodegradable synthetic polymer device that stimulates collagen production, leading to gradual volume restoration. It has been used worldwide for more than a decade to treat the lines and wrinkles of the aging face and in individuals with the human immunodeficiency virus for treatment of facial lipoatrophy., Objective: To provide an overview of the experience with injectable PLLA in Europe and the United States and the practices that have improved product use., Materials and Methods: A review of the literature was conducted, and the authors' clinical experience was included detailing the evolution of the use of injectable PLLA for facial restoration., Results: Although relatively high rates of nodule and papule formation were reported during early use of injectable PLLA, updated methods have led to better safety and efficacy, including patient selection, preparation, and instruction; product preparation; timing of injections and avoidance of overcorrection; an updated understanding of the anatomy of the aging face; and site-specific injection techniques., Conclusion: Important lessons have been learned that have enhanced the safety and efficacy of injectable PLLA and have made it a desirable product for restoring facial volume., (© 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

In this issue Fromy et al. describe alterations in pressure-induced vasodilation in the populations most prone to development of pressure ulcers of the skin. Advancing our understanding regarding the basic pathophysiological mechanisms mediating the development of pressure ulcers will allow for better delineation of populations at risk. This study provides novel insights into this important and poorly understood entity, using tools that are potentially deployable into clinical practice.

Purpose: Studies in on-call residents have shown that mood is worsened by fatigue as indicated by increased scores on measures of depression, anxiety, confusion, and anger using the Profile of Mood States (POMS). In prior sleep deprivation studies, mood has been shown to be more affected than either cognitive or motor performances. The purpose of this study was to examine the effect of the 80-hour work week regulations on resident mood in general and in a post-call period (PC)., Methods: Institutional Review Board approval was obtained to survey the residents and publish the results. POMS is a 65-item adjective questionnaire that includes subscales for measuring tension-anxiety, anger-hostility, depression-dejection, vigor-activity, fatigue-inertia, and confusion-bewilderment, with the summation of the scales forming a total mood disturbance score. Surgical residents were tested at a 9 am didactic curriculum session (9 am has been shown to correlate with the nadir of performance). Residents were tested after nights off call (NOC) or after PC. Time asleep in the preceding 24 hours and other demographic data were also collected. Acute fatigue (AF) was defined as <4 hours sleep. The two-sample t-test and linear regression were used to assess differences between groups., Results: A total of 123 standardized POMS mood questionnaires were administered on 4 occasions to 51 surgical residents, 35 men and 16 women at levels PGY-1 through PGY-5. Overall, 33 tests (27%) were taken after PC and 90 (73%) were taken after NOC. Acute fatigue residents had a mean sleep time of 2.2 (+/-1.5) hours, whereas rested (R) residents had a mean sleep time of 6.7 (+/-2.2) hours (whether PC or NOC). No statistical differences in mean values of vigor, anger, depression, concentration, fatigue, tension, or total score were observed between PC and NOC or between AF and R residents. There was no significant relationship between acute sleep deprivation and total mood disturbance, whether PC or NOC. In linear relationships, NOC total score and hours slept had r2 = 0.01 (p = 0.44), whereas PC total score and hours slept had r2 = 0.07 (p = 0.14)., Conclusion: Although POMS was given 4 times, only 27% were PC, which reflects our 1 in 4 night in-house coverage. In contrast to earlier studies, resident mood, as measured by POMS, is no longer related to PC/NOC or acute fatigue. Previous studies have shown that loss of sleep was associated with declining mood. The lack of such a relationship in this study may be related to the new regulations. It has been assumed that people can adapt to chronic sleep loss but have a harder time coping with the effects of acute sleep deprivation. If, however, the new regulations have relieved chronic sleep deprivation, then a well-rested resident can periodically cope with the effects of acute sleep deprivation. Perhaps by eliminating chronic sleep debt, work hour restrictions seem to have removed the negative impact of PC seen in the prior era. Further studies should increase the number of residents studied, have numerous repeat NOC and PC pairs in same subjects, compare different services with different workloads, junior and senior residents, and in-house and at-home call schedules.