Interest and Utility of MC1R Testing for Melanoma Risk in Dermatology Patients with a History of Nonmelanoma Skin Cancer.

Public access to genetic information is increasing, and community dermatologists may progressively encounter patients interested in genetic testing for melanoma risk. Clarifying potential utility will help plan for this inevitability. We determined interest and uptake of genetic risk feedback based on melanocortin receptor gene (MC1R) variants, immediate (two weeks) responses to risk feedback, and test utility at three months in patients (age ≥ 18, with a history of nonmelanoma skin cancer). Participants (N = 50) completed a baseline survey and were invited to consider MC1R testing via the study website. Testing interest and uptake were assessed through registration of test decision, request of a saliva test kit, and kit return (all yes/no). Immediate responses to risk feedback included feedback-relevant thoughts, emotions, communication, and information seeking after result receipt; test utility outcomes included family and physician communication and information seeking. Results indicated good retention at both time points (76%; 74%). Half (48%) logged onto the study website, and of these, most (92%) chose testing and (95%) returned a saliva sample. After two weeks, most (94%) had read all the risk feedback information and distress was low (M = 8.81, 7-28, SD = 2.23). Many (69%) had talked with their family about the results. By three months, most had spoken with family (92%) and physicians (80%) about skin cancer risk. Physician communication was higher (70%) in those tested versus those not tested (40%, p = 0.02). The substantial interest and promising outcomes associated with MC1R genetic testing in dermatology patients inform intervention strategies to enhance benefits and minimize risks of skin cancer genetic testing.

The Effects of Smoking on Hair Health: A Systematic Review.

Smoking is not only a preventable cause of significant systemic disease but also affects the follicular growth cycle and fiber pigmentation. Ambient tobacco smoke exposure results in nicotine accumulation in hair follicles and the hair shaft. This review summarizes the evidence on the association between smoking and hair health, as denoted by alopecia and premature hair graying (PHG). In July 2020, a review of the literature using PubMed/MEDLINE and CINAHL databases identified 32 studies investigating the relationship between smoking, PHG, and alopecia (androgenetic alopecia and frontal fibrosing alopecia). The prevalence of hair loss and PHG is more prevalent in smokers than nonsmokers. Smoking is associated with negative effects on hair health as evidenced in PHG and alopecia. Smoking status should be assessed in patients who are presenting to their dermatologist for evaluation of alopecia and PHG.

Adverse Events Associated With Cryolipolysis: A Systematic Review of the Literature.

BACKGROUND: Cryolipolysis is a popular procedure for people seeking noninvasive body contouring. As with any novel therapy, it is critical for providers to familiarize themselves with related adverse events (AEs), to provide appropriate information to patients before treatment. OBJECTIVE: To describe reported complications and AEs associated with cryolipolysis. MATERIALS AND METHODS: A systematic review was completed using the PubMed database and following search terms: "cryolipolysis" or "lipocryolysis" or "CoolSculpting." Only randomized clinical trials, prospective cohort studies, retrospective studies, case series, and case reports describing AEs related to cryolipolysis as well as studies written in English were included for review. RESULTS: Fifty-three articles were included in this review. The most common AEs associated with cryolipolysis were treatment site erythema, numbness/paresthesia, bruising, and edema. More serious complications of cryolipolysis include severe/persistent pain, dysesthesia, skin hyperpigmentation, motor neuropathy, and paradoxical adipose hyperplasia. CONCLUSION: Cryolipolysis is a safe option for patients seeking noninvasive body contouring. Most reported AEs are minimal and resolve quickly. It is important that physicians are aware of serious, irreversible AEs and are prepared to counsel patients appropriately before treatment.

The Effect of a Screen Protector on Blue Light Intensity Emitted from Different Hand-held Devices.

PURPOSE: In response to growing concern about the effect of blue light on ocular tissue, companies have created mobile device screen protectors to block blue light. This project evaluates one of these screen protectors' ability to reduce blue light intensity. METHODS: The intensity of light at 450 nm from an iPhone 8, iPhone X, and iPad was measured in a dark room. The averages of three measurements were taken with and without the screen protector at different distances, settings of brightness, and Apple's night shift (NS) mode. Results were analyzed using paired t-tests. RESULTS: At 33 cm, 100% brightness, and 0% NS, the screen protector decreased intensity by 43.9%, 32.3%, and 34.9% for the iPhone 8, iPhone X, and iPad, respectively. At 33 cm and 100% brightness, increasing NS mode from 0% to 100% decreased intensity by 81.2%, 84.2%, and 86.5%. At 33 cm without NS, decreasing the brightness from 100% to 0% decreased intensity by 99.5%, 99.8%, and 97.8%. CONCLUSIONS: The screen protector decreased the intensity at 450 nm for every setting other than those at 0% brightness. Decreasing brightness and applying NS mode were more effective in reducing blue light. More research is needed to determine the benefits of decreasing blue light exposure from electronic devices.

Biomechanical Analysis of Single-, Double-, and Triple-Bundle Configurations for Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tapes: A Cadaveric Study.

PURPOSE: To compare the acromioclavicular (AC) joint stability of single-bundle (SB), double-bundle with an anterolateral limb (DBa), double-bundle with a posterolateral limb (DBp), and triple-bundle (TB) coracoclavicular (CC) ligament reconstructions using cortical fixation buttons with suture tapes. METHODS: Eight cadaveric shoulders were used. AC joint translation and rotational stability were tested for intact and following 4 different CC reconstruction techniques: SB, DBa, DBp, and TB configurations using cortical fixation buttons with suture tapes. For each reconstruction and native AC joint as control, anteroposterior (AP) and superoinferior translations were quantified using 10- and 15-N translational loads and anterior and posterior rotations were measured using 0.16- and 0.32-Nm rotational torque. RESULTS: DBp reconstruction showed significantly better AP stability compared with SB and DBa reconstruction at 10 and 15 N (DBp: 4.1 ± 0.6 mm, SB: 7.8 ± 1.1 mm, P < .001; DBa: 6.5 ± 0.7 mm, P = .02 at 10 N; DBp: 5.5 ± 0.8 mm, SB: 10.1 ± 1.0 mm, P = .003; DBa: 9.1 ± 0.7 mm, P = .02 at 15 N). The degree of total rotation showed tendency to decrease according to increasing number of bundles; however, there were no significant differences (SB: 43.1 ± 9.2°, DBa: 37.9 ± 7.3°, DBp: 33.9 ± 6.8°, TB: 32.2 ± 6.6°, P = .37 at 0.32 Nm). CONCLUSIONS: An additional posterolateral clavicular hole for CC ligament reconstruction using cortical fixation buttons with suture tapes resulted in better AP stability compared with SB reconstruction, whereas use of additional anterolateral clavicular hole did not show any improvement compared with SB reconstruction. Reconstruction using both anterolateral and posterolateral clavicular holes did not guarantee better stability compared with SB reconstruction. There was an increasing tendency of rotational stability with number of bundle increases, although they did not reach statistical difference. CLINICAL RELEVANCE: When surgeons consider double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes, it is better to position the lateral clavicular hole posteriorly to restore AP stability.

Biomechanical effects of position and angle of insertion for all-suture anchors in arthroscopic Bankart repair.

BACKGROUND: The biomechanical properties of all-suture anchor for labral repair depending on the insertion angle and location are lacking. The purpose of this study was to quantify the biomechanical fixation characteristics of the anchor position and insertion angle of all-suture anchors for arthroscopic Bankart repair. METHODS: Twenty-four fresh frozen cadaveric glenoid were used. All-suture anchors with 1.5-mm diameter were randomly inserted at 2:30, 4:00, and 5:30 o'clock positions on the glenoid edge, with either 30°, 45° or 60° insertion angles to the mediolateral axis of the glenoid. Anchors were preloaded to 5 N and cyclically loaded from 5 N to 20 N for 10 cycles, followed by a load to failure test at 60 mm/min. Permanent, non-recoverable displacement was quantified at the end of the cyclic loading test to yield load. FINDINGS: All-suture anchors implanted at the 2:30 o'clock position of the glenoid provided greater stiffness, yield load, and ultimate load than those inserted at the 4:00 and 5:30 o'clock positions, regardless of the insertion angle. Displacement at yield and ultimate load were similar among the positions and insertion angles (yield load, vs. 4:00, p = 0.01; vs. 5:30, p = 0.045; ultimate load, vs. 4:00, p < 0.01; vs. 5:30, p < 0.01). The insertion angles of 30°, 45° and 60° did not influence mechanical stability between the 4:00 and 5:30 o'clock positions. INTERPRETATION: The insertion angle of all-suture anchors does not significantly affect the stability at antero-inferior quadrant of the glenoid.

Outcomes following laparoscopic transhiatal esophagectomy for esophageal cancer.

BACKGROUND: Most published minimally invasive esophagectomy techniques involve a multiple field approach, including laparoscopic and thoracoscopic esophageal mobilization. Laparoscopic transhiatal esophagectomy (LTE) should potentially reduce the complications associated with thoracotomy. This study aims to compare outcomes of LTE with open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE). METHODS: Retrospective chart review was performed on all patients who had an LTE for cancer between July 2008 and July 2012 at our institution. Data was compared with an historic cohort of patients who underwent OTE and EBE at the same institution from July 2002 to July 2008. RESULTS: There were 33 patients with LTE, compared with 60 patients with OTE and 139 with EBE. The presence of minor operative complications was similar (p = 0.36), but major complications were significantly less common in the LTE group (12, 23 and 33 %, respectively; p = 0.04). The median number of blood transfusions during hospitalization was significantly lower in the LTE group (0, 2.5 and 3, respectively; p = 0.005). Median tumor size was significantly smaller (1.5, 2.2, and 3 cm, respectively; p = 0.03), but the LTE group had a significantly higher percentage of patients with neoadjuvant treatment (39, 14 and 29 %, respectively; p = 0.008). Median lymph node yield for LTE was lower (24, 36 and 48, respectively; p < 0.0001), but the percentage of patients with positive nodes was similar (33, 33 and 39 %, respectively; p = 0.69). Mortality was equivalent among the groups (0, 2 and 4 %, respectively; p = 0.38). The median LOS for the LTE group was significantly lower (10, 13 and 15 days, respectively; p < 0.0001). Overall survival was not different between the three groups (p = 0.65), with median survival at 24 months of 70, 65 and 65 %, respectively. CONCLUSION: LTE can be performed safely with less major complications and shorter hospital stay than open esophagectomy. The reduced lymph-node harvest did not impact overall survival.