Comparative Analysis of Taper Point and Reverse Cutting Needles on Skin Puncture Force.

BACKGROUND: Reverse cutting needles are commonly used in cutaneous surgery due to their perceived ease of use. Despite this, there is limited research evaluating the force required to puncture skin using contemporary needles. OBJECTIVE: This study aims to compare the puncture forces required for two different needle geometries across various gauge sizes. MATERIALS AND METHODS: The authors assessed the force necessary to penetrate samples of human abdominal skin samples using taper needles of three different United States Pharmacopeia gauge sizes with their respective reverse cutting needle counterparts. Taper point needles tested were RB-1 (3-0), TF (4-0), and C-1 (5-0), while reverse cutting needles included PS-2 (3-0) and P-3 (4-0, 5-0). An electronic force meter was used to record the puncture force required by each needle type. RESULTS: The mean puncture force in newtons (N) for taper point needles was 1.00, 0.74, and 0.48 for RB-1, TF, and C-1, respectively. The mean puncture force for reverse cutting needles was 0.95 N, 0.60 N, and 0.51 N for PS-2, P-3 (4-0), and P-3 (5-0), respectively. There was a direct relationship between needle body diameter and puncture force for both needle geometries. CONCLUSION: There was no clinically significant difference in skin puncture force between needle geometries.

Impact of Needle Design and Suture Gauge on Tissue Tearing During Skin Suturing: A Comparative Analysis.

BACKGROUND: Surgeons face numerous choices in selecting sutures for skin closure, with potential adverse effects such as tissue tearing. OBJECTIVE: To investigate the influence of needle design and suture gauge on tissue tearing during suturing procedures. MATERIALS AND METHODS: The authors tested the tear-through force in Newtons for 3 needle types and 3 suture gauges using an artificial skin model and a professional-grade tensiometer. Suture material was secured into the skin model, and force was applied to the suture at a constant rate, resulting in tearing. Force-displacement and force-time curves were generated. Evaluation included conventional cutting (PC-3), reverse cutting (PS-3), and taper point (BB) needles with a 5-0 polypropylene suture. In addition, nylon sutures with a reverse cutting needle (PS-2) were tested at 3 suture gauges (5-0, 4-0, 3-0). RESULTS: The mean tear-through forces for PC-3, PS-3, and BB were 3.26 N, 3.75 N, and 4.07 N, respectively. For the 5-0, 4-0, and 3-0 nylon sutures, the mean tear-through forces were 3.44 N, 3.81 N, and 4.04 N, respectively. Statistical analysis revealed a significant impact of suture gauge size (p < .001) and needle geometry (p < .001) on tear-through force. CONCLUSION: Larger suture diameter and taper needles minimize tissue tearing.

A Randomized, Single-Center, Double-Blind, Controlled Case Study Evaluating Procedure Pairing of a Neurocosmetic Postprocedure Cream With Radiofrequency Microneedling for Facial Rejuvenation.

BACKGROUND: Radiofrequency (RF) microneedling produces patient discomfort which deters patients from completing the recommended treatment series. OBJECTIVE: The primary objective was to determine the tolerability, safety, and efficacy of a neurocosmetic postprocedure cream post-RF microneedling in reducing patient discomfort and enhancing recovery across the length of the study and, secondarily, to evaluate against a leading comparator. The third objective was to evaluate the efficacy of the neurocosmetic on self-perceived improvement and objective grading. MATERIALS AND METHODS: An Institutional Review Board (IRB) approved, fourteen-day, randomized, single-center, double-blind, controlled clinical case study was conducted with 11 healthy female subjects, 6 randomized to the neurocosmetic and 5 to the comparator cell. Following a 7-day washout period, subjects received RF microneedling (face and neck) and applied the postprocedure cream twice daily for 7 days. Objective and subjective tolerability, self-assessments, and clinical photography were performed immediately postprocedure, 24 h, three and seven days following the procedure. RESULTS: The neurocosmetic was tolerable and safe. Erythema and stinging immediately decreased postprocedure, postneurocosmetic application. After 24 h, 83% favorably agreed the neurocosmetic "reduced irritation on the skin post-procedure," and after 7 days, 100% favorably agreed "experience with the product was positive and I would be interested in returning for a second treatment." The neurocosmetic reduced skin tone redness in the face and neck faster and to a greater degree when measured against a comparator. CONCLUSION: The neurocosmetic postprocedure cream improved patient discomfort and enhanced recovery when used immediately post-RF microneedling and after 7 days. IRB PROTOCOL NUMBER: Pro00064211.

Medical Student Mentorship for Undergraduate Students Underrepresented in Medicine Improves Confidence and Knowledge About Medical School Application.

Purpose Applying to medical school is accompanied by significant barriers to prospective applicants. Students who are underrepresented in medicine (URiM) may face additional barriers. We created a mentorship program to pair pre-medical URiM students with medical student mentors. The purpose of this study was to determine if providing mentorship and resources to URiM pre-medical students increased their knowledge and confidence regarding the medical school application process. Method A survey was emailed to mentees of the program to assess their knowledge and confidence about the Medical College Admission Test (MCAT) and medical school application before and after receiving mentorship. Wilcoxon-Signed-Rank tests were used for data analysis. Results A total of 28 participants completed the pilot study of which 17 gave qualitative feedback. Students reported feeling significantly more knowledgeable and confident after six months of enrollment on seven (77.8%) of the survey items. Respondents agreed that mentorship was the most valuable aspect of the program, with 13 (76.5%) respondents qualitatively endorsing the positive impact mentorship imparted to them. Conclusion Having a medical student mentor helped URiM pre-medical students feel more knowledgeable and confident about the medical school application process. By providing URiM students with additional resources, the diversity of future classes of physicians may improve and better mirror the populations they will serve.

Extracellular purines in lung endothelial permeability and pulmonary diseases.

The purinergic signaling system is an evolutionarily conserved and critical regulatory circuit that maintains homeostatic balance across various organ systems and cell types by providing compensatory responses to diverse pathologies. Despite cardiovascular diseases taking a leading position in human morbidity and mortality worldwide, pulmonary diseases represent significant health concerns as well. The endothelium of both pulmonary and systemic circulation (bronchial vessels) plays a pivotal role in maintaining lung tissue homeostasis by providing an active barrier and modulating adhesion and infiltration of inflammatory cells. However, investigations into purinergic regulation of lung endothelium have remained limited, despite widespread recognition of the role of extracellular nucleotides and adenosine in hypoxic, inflammatory, and immune responses within the pulmonary microenvironment. In this review, we provide an overview of the basic aspects of purinergic signaling in vascular endothelium and highlight recent studies focusing on pulmonary microvascular endothelial cells and endothelial cells from the pulmonary artery vasa vasorum. Through this compilation of research findings, we aim to shed light on the emerging insights into the purinergic modulation of pulmonary endothelial function and its implications for lung health and disease.

The intersection of melanoma survival and social determinants of health in the United States: A systematic review.

Background: Despite recent improvements in melanoma survival rates, persistent inequalities pose barriers to care for some patients. Objective: To assess the influence of social determinants of health (SDoH) on melanoma treatment outcomes. Methods: A systematic review (Prospective Register of Systematic Reviews CRD42022346854) of manuscripts that examined the association between SDoH and melanoma treatment-related outcomes in the United States was conducted using 5 databases. Results: The analysis encompassed data from 12 retrospective manuscripts. The SDoH domains most frequently investigated were health care access and quality (n = 6 manuscripts, 50%) and economic stability (n = 7, 58.3%). Other domains included social and community context (n = 5, 41.7%) and education access (n = 3, 25%). These findings revealed significant correlations between poor melanoma survival and low levels of economic stability, limited education, government health insurance, and being uninsured and unmarried. Limitations: Many SDoH were not analyzed at the patient level. SDoH are vast categories, but manuscripts usually analyze one aspect of a particular category. Conclusions: These results highlight the need for physicians to recognize the substantial impact of SDoH on melanoma outcomes and to adopt more comprehensive strategies focused on patient-centered care. Integrating social support mechanisms into clinical practice emerges as a key mechanism to promote equitable and effective interventions.

Zinc-Dependent Histone Deacetylases in Lung Endothelial Pathobiology.

A monolayer of endothelial cells (ECs) lines the lumen of blood vessels and, as such, provides a semi-selective barrier between the blood and the interstitial space. Compromise of the lung EC barrier due to inflammatory or toxic events may result in pulmonary edema, which is a cardinal feature of acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS). The EC functions are controlled, at least in part, via epigenetic mechanisms mediated by histone deacetylases (HDACs). Zinc-dependent HDACs represent the largest group of HDACs and are activated by Zn2+. Members of this HDAC group are involved in epigenetic regulation primarily by modifying the structure of chromatin upon removal of acetyl groups from histones. In addition, they can deacetylate many non-histone histone proteins, including those located in extranuclear compartments. Recently, the therapeutic potential of inhibiting zinc-dependent HDACs for EC barrier preservation has gained momentum. However, the role of specific HDAC subtypes in EC barrier regulation remains largely unknown. This review aims to provide an update on the role of zinc-dependent HDACs in endothelial dysfunction and its related diseases. We will broadly focus on biological contributions, signaling pathways and transcriptional roles of HDACs in endothelial pathobiology associated mainly with lung diseases, and we will discuss the potential of their inhibitors for lung injury prevention.

Cutaneous tuberculosis in the pediatric population: A review.

Importance: Tuberculosis (TB) is a significant health concern, affecting over 1.5 million people annually worldwide, with the incidence increasing in the United States from 2020 to 2021. The pediatric population is particularly vulnerable to TB. Extrapulmonary manifestations of TB include cutaneous tuberculosis (CTB). Observations: There are 8 forms of CTB. Lupus vulgaris (LV) is the second most common form of pediatric CTB which presents nontender plaques or nodules with ulceration that progress to well-defined, scaly plaques. Tuberculous chancre results from exogenous inoculation and lesions contain large amounts of acid-fast bacilli (AFB). Clinically, tuberculous chancre presents as erythematous papules which form firm nontender ulcers. Tuberculosis verrucose cutis (TVC) presents as small papules surrounded by inflammation that develops into a wart-like lesion. Periorificial lesions are rare and present as painful ulcers in the oral or perineal regions. Scrofuloderma is the most common form of pediatric CTB and presents as nodules that ulcerate, forming purulent sinus tracts. Tuberculosis miliaris cutis disseminate presents as widespread papules and crusted vesicles. Metastatic abscesses present as multiple nodules that may ulcerate or form draining sinus tracts. Lastly, tuberculid forms include lichen scrofulosorum (LS), which presents as lichenoid papules which may form plaques and scale, and papulonecrotic tuberculid, which presents as necrotic papules. All forms of cutaneous tuberculosis can be treated with the standard 6-month, four-drug anti-tuberculosis treatment (ATT). Some cases of CTB may require debriding and surgical management in addition to ATT. Conclusions and Relevance: Determining the type of CTB can be challenging clinically. Histopathology is needed to make the diagnosis. Chest x-ray and a review of systems should be obtained for CTB patients to determine if there are other extrapulmonary manifestations of TB. All types are treated with 6 months of ATT.

Concomitant EGFR Mutations and ALK Rearrangements in Lung Adenocarcinoma Treated With Osimertinib.

Lung cancer is the third most common cancer in addition to being the cancer responsible for the most annual deaths in the United States, comprising 15% of all diagnosed cancers, and 28% of all cancer deaths in 2020. Major advances in survival are because of gene sequencing and the advent of targeted biological therapy. The prevalence of epidermal growth factor receptor (EGFR) mutations coexisting with anaplastic lymphoma kinase (ALK) rearrangements is quite low. However, the clinical relevance and effective treatment of these cancers require further investigation. This case series describes two patients diagnosed with stage IV adenocarcinoma with coexisting EGFR and ALK rearrangements. In Case 1, a 73-year-old male presented with worsening ataxia and headaches. In Case 2, a 64-year-old female presented with worsening dyspnea. Molecular studies revealed ALK gene fusion and the L861Q EGFR mutation in Case 1 and L858R EGFR mutation and ALK gene fusion in Case 2. Both patients received a gamma knife and an EGFR-tyrosine kinase inhibitor (TKI), osimertinib. In one of the cases, following the discovery of new brain metastases, the dose of osimertinib was increased from 80 to 160 mg. The patient passed away nine months after beginning EGFR-TKI treatment, one month after increasing the dose. The second patient experienced a significant interval reduction in the size of enhancing metastasis in both the right frontal and left parietal lobe after four months of EGFR-TKI treatment. The cases of coexisting EGFR mutations and ALK rearrangements are quite rare, and treatment can be challenging. Here, EGFR-TKI had a mixed response among our patients.