Search

Extracorporeal photopheresis (ECP) is an apheresis procedure that is conventionally used as a first-line treatment for cutaneous and leukemic subtypes of T-cell lymphoma, such as Sezary's syndrome and mycosis fungoides. Over the past three decades, its immunotherapeutic properties have been tested on a variety of autoimmune conditions, including many dermatologic diseases. There is ample evidence of ECP's ability to modify leukocytes and alter cytokine production for certain dermatologic diseases that have been refractory to first-line treatments, such as atopic dermatitis. However, the evidence on the efficacy of ECP for the treatment of these dermatologic diseases is unclear and/or lacks sufficient evidence. The purpose of this paper is to review the literature on the utilization and clinical efficacy of ECP in the treatment of several [autoimmune] dermatologic diseases and discuss its applications, guidelines, recommendations, and future implementation for dermatologic diseases.

Morbidity and mortality from skin cancer continue to rise domestically and globally, and melanoma and non-melanoma skin cancers are a topic of interest in the dermatology and oncology communities. In this review, we summarize the stimulator of interferon genes (STING) pathway, its specific role in the pathogenesis of DNA damage and skin cancer, and STING-specific therapies that may fight both melanoma and non-melanoma skin (NMSC) cancers. Furthermore, we discuss specific portions of the STING pathway that may be used in addition to previously used therapies to provide a synergistic effect in future oncology treatments and discuss the limitations of current STING-based therapies.

Background: First assistance during metabolic and bariatric surgery (MBS) often consists of either a general surgery resident (GSR), minimally invasive surgery fellow (MISF), or advanced practice provider (APP). While APPs may be consistent members of the bariatric team, GSRs and MISFs are often rotating members. It is unclear to what extent the inclusion of APPs versus surgical trainees (GSRs or MISFs) affect surgical outcomes., Objectives: The aim of this study was to determine the effect of first assistant type on adverse outcomes following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB)., Setting: Academic hospital., Methods: From the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databases, we identified conventional laparoscopic and robot-assisted SG or RYGB performed with an APP, GSR, or MISF as first assistant. Patient demographics, co-morbidities, and operative characteristics were used to create 1:1 case-matched first-assistant cohorts, and perioperative outcomes were compared. Variables were compared using the χ 2 test, Mann-Whitney U test, and regression models. Analyses were performed with StataMP 17. A P value <.05 and a 95% confidence interval exclusive of 1 or 0 were considered statistically significant., Results: Of 414,623 included cases, an APP, GSR, and MISF served as first assistant in 58%, 28%, and 14%, respectively. Mean operative length was longer in GSR (P < .001) and MISF (P < .001) versus APP cases and similar between GSR and MISF cases (P = .08). Compared with an APP as first assistant, the odds of approach conversion (P < .001), readmission (P < .001), and overall morbidity (P < .001) were significantly higher in GSR and MISF cases. Compared with an APP, GSR cases also were associated with higher odds of admission to the intensive care unit (P < .001), reintervention (P < .001), bleeding (P = .002), venous thromboembolism (P < .001), and surgical site infection (P < .001). Most outcomes were similar between GSR and MISF as first assistant cases., Conclusions: While training future surgeons is an important aspect of bariatric surgery, inexperienced trainees or shifting roles within a surgical team may confer increased surgical risks to patients. Strategies are needed to optimize patient safety while maintaining a robust resident experience., (Copyright © 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to compare the leakage rates of perilimbal uniplanar and biplanar clear corneal incisions in dogs when subjected to increased intraocular pressure (IOP) both from within the eye and via external pressure., Procedure: Uniplanar clear corneal incisions were created in eight freshly enucleated canine eyes using a 3.2 mm straight slit knife while 8 fellow eyes received a biplanar clear corneal incision consisting of an approximately 300 μm deep groove followed by a 3.2 mm straight slit knife entry into the anterior chamber. Both wounds were reapposed using three simple interrupted 8-0 polyglactin 910 sutures. Eyes were cannulated with two 25 g needles: One connected to a pressure transducer, and the other connected to a reservoir of isotonic saline. The IOP at which the wound leaked was recorded when the intraocular pressure was increased internally by raising the height of the fluid bag, and again when the cornea was externally compressed. Kaplan-Meier survival curves compared incision types for each method of increasing IOP and were evaluated using Mantel-Cox log-rank analysis., Results: Both wound types resisted leakage at IOP in the physiologically achievable range and no significant differences were observed between clear corneal incisions when pressure was applied externally (P = .353) or was increased from within the globe (P = .615)., Conclusion: Ex vivo uniplanar and biplanar clear corneal incisions in dogs are equally strong, with no significant differences in leakage rates when IOP is increased internally or externally., (© 2019 American College of Veterinary Ophthalmologists.)