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Background: Adherence to subcutaneous biologic agents for the treatment of psoriasis can be negatively influenced by injection pain.Objective: To explore the differences in injection site pain when patients are pre-treated with heat or cold, versus no pre-treatment prior to administration of a subcutaneous biologic agent.Methods: In an observational cohort study, patients receiving subcutaneous injections of ustekinumab were randomly assigned to receive pretreatment with ice, heat, or no intervention over three visits. Post-dose, patients rated pain on a 100 mm visual analogue scale (VAS).Results: There was an increase in the VAS score for both heat (2.51, P=0.30) and ice (3.33, P=0.16), compared to no intervention. No differences were found between the two intervention groups (-0.83, P=0.73). On average, females had the same VAS scores with ice compared to that of no intervention (-0.12, P=0.97) and a non–significant decrease of 3.29 points (P=0.38) with heat. Males had increased pain scores by 5.65 points (P=0.07) with ice and by 6.39 points (P=0.04) with heat.Limitations: Pain is a subjective measurement and objective quantification is difficult.Conclusions: On average, neither heat nor cold application reliably reduced pain. Our results do not support the application of heat or cold prior to ustekinumab injection.

Actinic keratosis (AK) is a common dermatologic condition in which hyperplastic epidermal lesions develop in response to excessive and chronic exposure to ultraviolet (UV) radiation. If left untreated, AK can progress to squamous cell carcinomas of the skin. Incidence is rising worldwide as a result of the progressive aging of populations and an increase in lifetime cumulative exposure to UV radiation. Currently, various treatment options exist, which range from topical medications to light-based therapies and procedural modalities. In this article, we will review the treatment options for AK with a focus on assessments of patient satisfaction with treatment.

Psoriasis and Crohn's disease are autoimmune diseases believed to share a similar pathogenesis. Ustekinumab is FDA-approved for treatment of psoriasis in 45 mg and 90 mg dosages and is undergoing phase III trials for Crohn's disease in higher dosages. Data on ustekinumab in guttate psoriasis (GP) are limited. We report the case of a 21-year-old female with Crohn's disease on adalimumab who developed severe, generalized GP 2 months after a streptococcal infection. Her GP did not regress after discontinuation of adalimumab. She began ustekinumab 45 mg every 12 weeks, which led to complete regression of her psoriasis. Due to persistent bowel symptoms, ustekinumab was increased to 135 mg every 8 weeks, with improvement. In this case, GP may have been related to recent streptococcal infection, or a complication of TNF-inhibitor therapy. Here, we show ustekinumab has potential as a therapeutic option for both GP and Crohn's disease.

Background In recent years, the number of agents for treatment of plaque psoriasis has increased rapidly. Objective To compare available and investigational agents for treatment of psoriasis. Methods Pivotal clinical trials for infliximab, etanercept, adalimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, methotrexate, tofacitinib, and apremilast in plaque psoriasis were identified. Percentages of patients achieving PASI 75, 90, and 100 were extracted. Results Seventeen publications, including data from 21 trials, were reviewed. All medications were more efficacious in achieving PASI 75 compared to placebo. Ixekizumab exhibited the greatest difference in PASI 75 and PASI 90, while brodalumab showed the greatest difference in PASI 100. Limitations Heterogeneity existed in patient demographics and study design including primary endpoint weeks between trials. Data included were only from the primary endpoint week. Conclusions All biologics exhibited greater PASI improvement than placebo, with newer agents more capable of achieving PASI 90 and PASI 100. Head-to-head comparator trials are needed for more accurate comparison.

Psoriasis and psoriatic arthritis are chronic, inflammatory, immune-mediated diseases that affect the skin and joints, respectively. The older systemic agents that have been used to treat these conditions are associated with many side effects, including an increased risk of malignancies, specifically lymphoma. In the last few years, there has been a wave of development of novel systemic biologic therapies to target psoriasis and psoriatic arthritis. While long-term safety data is lacking, the newer therapies targeting interleukins 12, 23, and 17 reveal a much more favorable side effect profile, specifically with regards to lymphoma. Here we report two cases of patients with psoriasis and psoriatic arthritis who had histories of lymphoma, both successfully treated with an interleukin-17 inhibitor without any recurrence or worsening of lymphoproliferative disease.

Objective This study sought to determine if 3-dimensional (3D) echocardiography would more closely correspond to direct surgical measurements of the maximal tricuspid valve (TV) annular diameter than 2-dimensional (2D) measurements. Design Prospective study. Setting The cardiothoracic operating rooms (ORs) at Mount Sinai Medical Center in New York, NY. Participants Fifty-nine patients over 18 years of age underwent elective mitral valve surgery for severe mitral regurgitation from 2014 to 2015. Interventions None. Measurements and Main Results Two-dimensional and 3D data sets and surgical TV annular dimensions were measured. Bland-Altman analysis was conducted and absolute differences were compared using paired t tests and the McNemar test. The observed mean difference between the 2D measurements by transgastric right ventricular diastolic view and the surgical measurements was 0.21 cm (standard deviation [SD] = 0.36 cm); the mean difference between the 3D measurements and surgical measures was -0.03 cm (SD = 0.19 cm). The McNemar test showed that the rate of highly successful measurements, defined as those within 0.2 cm of the true surgical score, using the 3D technique (66%) was significantly better than the rate of highly successful measurements using the 2D technique (25%), p Conclusion Three-dimensional imaging and measurement of the TV annular diameter is feasible in the OR setting. The superiority of the 3D measurements versus 2D measurements allows for greater precision and accuracy and may guide better intraoperative surgical decision-making.

Submental fat (SMF) accumulation is a cosmetically distressing concern for which there have been recent advances in minimally invasive and noninvasive therapeutic options. In this article, we review the newest treatments available for SMF, including laser-assisted lipolysis (LAL), radiofrequency (RF)-assisted lipolysis, deoxycholic acid (DCA), and noninvasive devices. These treatments provide additional options for patients seeking nonsurgical approaches to treatment of SMF.