Doxxing and Cyberbullying in Dermatology.

Doxxing, a type of cyberbullying, occurs when an individual's personal information is shared without consent and with malintent. Doxxing can be seen as a form of vigilantism, a way to hold others accountable for their actions or opinions; however, this form of justice can have catastrophic impacts on the victim, especially physicians. Since the COVID-19 pandemic, where physicians and healthcare providers strongly led public health advocacy efforts on social media, the frequency of doxxing and cyberbullying has increased. Diversity, Equity, and Inclusion (DEI) initiatives have also recently sparked controversy in dermatology and medicine, where advocates for DEI and those opposed to DEI initiatives have also been doxxed. This behavior is incredibly taxing on an individual's mental health, with substantial negative implications on a person's social, personal, and professional life. We discuss the ethical considerations of doxxing and avenues for better protecting physicians.

Endoscopic Versus Traditional Thoracic Discectomy: A Multicenter Retrospective Case Series and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Surgical treatment for symptomatic thoracic disc herniations (TDH) involves invasive open surgical approaches with relatively high complication rates and prolonged hospital stays. Although advantages of full endoscopic spine surgery (FESS) are well-established in lumbar disc herniations, data are limited for the endoscopic treatment of TDH despite potential benefits regarding surgical invasiveness. The aim of this study was to provide a comprehensive evaluation of potential benefits of FESS for the treatment of TDH. METHODS: PubMed, MEDLINE, EMBASE, and Scopus were systematically searched for the term "thoracic disc herniation" up to March 2023 and study quality appraised with a subsequent meta-analysis. Primary outcomes were perioperative complications, need for instrumentation, and reoperations. Simultaneously, we performed a multicenter retrospective evaluation of outcomes in patients undergoing full endoscopic thoracic discectomy. RESULTS: We identified 3190 patients from 108 studies for the traditional thoracic discectomy meta-analysis. Pooled incidence rates of complications were 25% (95% CI 0.22-0.29) for perioperative complications and 7% (95% CI 0.05-0.09) for reoperation. In this cohort, 37% (95% CI 0.26-0.49) of patients underwent instrumentation. The pooled mean for estimated blood loss for traditional approaches was 570 mL (95% CI 477.3-664.1) and 7.0 days (95% CI 5.91-8.14) for length of stay. For FESS, 41 patients from multiple institutions were retrospectively reviewed, perioperative complications were reported in 4 patients (9.7%), 4 (9.7%) required revision surgery, and 6 (14.6%) required instrumentation. Median blood loss was 5 mL (IQR 5-10), and length of stay was 0.43 days (IQR 0-1.23). CONCLUSION: The results suggest that full endoscopic thoracic discectomy is a safe and effective treatment option for patients with symptomatic TDH. When compared with open surgical approaches, FESS dramatically diminishes invasiveness, the rate of complications, and need for prolonged hospitalizations. Full endoscopic spine surgery has the capacity to alter the standard of care for TDH treatment toward an elective outpatient surgery.

Ultrastructural changes in chronic inflammatory enteropathies-a comparison between dogs and humans.

Chronic inflammatory enteropathies (CIEs) are an important group of diseases in dogs and involve complex pathogenetic aspects. Endoscopy and histopathology are vital for documenting the disease but are less useful for subclassifying CIEs and predicting the response to treatment. However, healing of the mucosal disease process (deep remission) and ultrastructural evaluation of the mucosa have received little attention in canine CIE. Given that canine CIE shares many similarities with inflammatory bowel diseases (IBDs) in human patients-and presents a good spontaneous disease model for human IBD-this perspective article evaluates the literature on ultrastructural lesions in canine CIE and human IBD and offers future directions for the study of ultrastructural mucosal lesions in canine CIE. Such lesions might have a higher sensitivity of detection than structural changes revealed upon light microscopy and may even precede or remain after the resolution of the clinical signs and histologic lesions.

Exploring the Effect of Specimen Size on Elastic Properties of Fused-Filament-Fabrication-Printed Polycarbonate and Thermoplastic Polyurethane.

Additive manufacturing (AM) is often used to create designs inspired by topology optimization and biological structures, yielding unique cross-sectional geometries spanning across scales. However, manufacturing defects intrinsic to AM can affect material properties, limiting the applicability of a uniform material model across diverse cross-sections. To examine this phenomenon, this paper explores the influence of specimen size and layer height on the compressive modulus of polycarbonate (PC) and thermoplastic polyurethane (TPU) specimens fabricated using fused filament fabrication (FFF). Micro-computed tomography imaging and compression testing were conducted on the printed samples. The results indicate that while variations in the modulus were statistically significant due to both layer height and size of the specimen in TPU, variations in PC were only statistically significant due to layer height. The highest elastic modulus was observed at a 0.2 mm layer height for both materials across different sizes. These findings offer valuable insights into design components for FFF, emphasizing the importance of considering mechanical property variations due to feature size, especially in TPU. Furthermore, locations with a higher probability of failure are recommended to be printed closer to the print bed, especially for TPU, because of the lower void volume fraction observed near the heated print bed.

Relevance and Ethical Issues of Diversity Equity and Inclusion Programs, circa 2024-2025.

A recent resolution with approximately 100 signatories entitled "Sunsetting All Diversity, Equity, and Inclusion (DEI) Programs" administered by the American Academy of Dermatology (AAD) sparked controversial debate within the field. Despite the AAD voting against the proposal to eliminate DEI initiatives, many underrepresented medical groups (URMs) wondered how to move forward and create safe spaces for everyone. We discuss the relevance of DEI programs in today's society and the ethical challenges that may arise. We conclude with actionable recommendations on how organizations can improve their current DEI strategies to ensure they are more inclusive and not perceived as discriminatory.

Changing Dermatologic Procedural Patterns in the Medicare Population: A National Trend Analysis.

BACKGROUND: Dermatologists are trained in diagnostic and therapeutic procedures for cutaneous lesions, yet comparative trends for basic dermatologic procedures across dermatology providers are lacking at the national level. OBJECTIVE: To trend common dermatologic procedures among general dermatologists, Mohs surgeons, primary care providers or primary care physicians (PCPs), and nonphysician clinicians (NPCs). METHODS: Longitudinal analysis of 2016 to 2021 Medicare Public Use Files. RESULTS: Aggregate dermatologic procedural volume decreased 3.0%. Procedural volume declined among general dermatologists (-11.7%), Mohs surgeons (-16.7%), and PCPs (-41.7%) but increased among NPCs (+57.5%). The proportion of procedures by general dermatologists decreased substantially for premalignant destructions (-6.2%), skin biopsies and shave removals (-4.7%), and malignant excisions (-4.1%) and more notably in counties that were nonmetro (-7.1%), low in income (-6.1%), and with <4.0 dermatologists per 100,000 population (-7.0%). CONCLUSION: Aggregate procedural volume decreased across the study period with general dermatologists, Mohs surgeons, and PCPs performing a progressively smaller proportion. The increase in procedures by NPCs may help to address demand but underscores the value of formalized procedural training. The procedural decline by general dermatologists in rural and low-income counties and those with baseline dermatologist shortages may exacerbate existing unmet need. Primary limitation included lack of commercial data.

How variable are the classic ERP effects during sentence processing? A systematic resampling analysis of the N400 and P600 effects.

Although event-related potential (ERP) research on language processing has capitalized on key, theoretically influential components such as the N400 and P600, their measurement properties-especially the variability in their temporal and spatial parameters-have rarely been examined. The current study examined the measurement properties of the N400 and P600 effects elicited by semantic and syntactic anomalies, respectively, during sentence processing. We used a bootstrap resampling procedure to randomly draw many thousands of resamples varying in sample size and stimulus count from a larger sample of 187 participants and 40 stimulus sentences of each type per condition. Our resampling investigation focused on three issues: (a) statistical power; (b) variability in the magnitudes of the effects; and (c) variability in the temporal and spatial profiles of the effects. At the level of grand averages, the N400 and P600 effects were both robust and substantial. However, across resamples, there was a high degree of variability in effect magnitudes, onset times, and scalp distributions, which may be greater than is currently appreciated in the literature, especially for the P600 effects. These results provide a useful basis for designing future studies using these two well-established ERP components. At the same time, the results also highlight challenges that need to be addressed in future research (e.g., how best to analyze the ERP data without engaging in such questionable research practices as p-hacking).

Risk and Resilience Variants in the Retinoic Acid Metabolic and Developmental Pathways Associated with Risk of FASD Outcomes.

Fetal Alcohol Spectrum Disorder (FASD) is a common neurodevelopmental disorder that affects an estimated 2-5% of North Americans. FASD is induced by prenatal alcohol exposure (PAE) during pregnancy and while there is a clear genetic contribution, few genetic factors are currently identified or understood. In this study, using a candidate gene approach, we performed a genetic variant analysis of retinoic acid (RA) metabolic and developmental signaling pathway genes on whole exome sequencing data of 23 FASD-diagnosed individuals. We found risk and resilience alleles in ADH and ALDH genes known to normally be involved in alcohol detoxification at the expense of RA production, causing RA deficiency, following PAE. Risk and resilience variants were also identified in RA-regulated developmental pathway genes, especially in SHH and WNT pathways. Notably, we also identified significant variants in the causative genes of rare neurodevelopmental disorders sharing comorbidities with FASD, including STRA6 (Matthew-Wood), SOX9 (Campomelic Dysplasia), FDG1 (Aarskog), and 22q11.2 deletion syndrome (TBX1). Although this is a small exploratory study, the findings support PAE-induced RA deficiency as a major etiology underlying FASD and suggest risk and resilience variants may be suitable biomarkers to determine the risk of FASD outcomes following PAE.

Examining treatment strategies for xanthelasma palpebrarum: a comprehensive literature review of contemporary modalities.

Xanthelasma palpebrarum (XP) is the predominant form of cutaneous xanthoma, as it accounts for greater than 95% of cases. It is characterized by the presence of foam cell clusters containing a large amount of low-density lipoprotein (LDL), which are located in the connective tissue of skin, tendons, and fascia. XP lesions commonly present as distinctive yellow-orange macules, papules, or nodules, and are primarily on the upper eyelids as well as the inner canthus. Women are affected twice as often as men, with lesions typically emerging between the ages of 35 and 55. The pathophysiology of XP involves abnormal lipid metabolism and is often associated with hyperlipidemic states like Type II and IV hyperlipidemia, hypothyroidism, weight gain, and fatty diet. Despite the availability of various treatment methods, current XP management lacks standardization, particularly due to limited comparative research. To address this gap, we conducted an extensive literature review of 45 studies published between 2012 to 2023, which provides an updated overview of current XP treatment modalities. This comprehensive analysis will inform researchers and clinicians on the evolving landscape of XP management.

Ethics of patients losing insurance coverage due to hospital-insurer contract disagreements Frank H. Netter MD School of Medicine at QuinnipiacUniversity, North Haven, Conneticut.

Despite most Americans having healthcare coverage, coverage does not equate to access. For many, healthcare coverage is being threatened by contractual disagreements between major health insurers and hospitals. In New York, in efforts to control costs, Aetna and United Healthcare have recently engaged in contentious contract negotiations with NewYork-Presbyterian and Mount Sinai medical centers, resulting in unprecedented ripples in patients' health plans and access. These disruptions have been shown to negatively impact patient health and result in patients managing their treatment at steep out-of-pocket rates or scrambling to find new providers in-network. We discuss the ethical implications of fallouts between insurance companies and hospitals and their impacts on patients.

Discovery of potent small-molecule inhibitors of lipoprotein(a) formation.

Lipoprotein(a) (Lp(a)), an independent, causal cardiovascular risk factor, is a lipoprotein particle that is formed by the interaction of a low-density lipoprotein (LDL) particle and apolipoprotein(a) (apo(a))1,2. Apo(a) first binds to lysine residues of apolipoprotein B-100 (apoB-100) on LDL through the Kringle IV (KIV) 7 and 8 domains, before a disulfide bond forms between apo(a) and apoB-100 to create Lp(a) (refs. 3-7). Here we show that the first step of Lp(a) formation can be inhibited through small-molecule interactions with apo(a) KIV7-8. We identify compounds that bind to apo(a) KIV7-8, and, through chemical optimization and further application of multivalency, we create compounds with subnanomolar potency that inhibit the formation of Lp(a). Oral doses of prototype compounds and a potent, multivalent disruptor, LY3473329 (muvalaplin), reduced the levels of Lp(a) in transgenic mice and in cynomolgus monkeys. Although multivalent molecules bind to the Kringle domains of rat plasminogen and reduce plasmin activity, species-selective differences in plasminogen sequences suggest that inhibitor molecules will reduce the levels of Lp(a), but not those of plasminogen, in humans. These data support the clinical development of LY3473329-which is already in phase 2 studies-as a potent and specific orally administered agent for reducing the levels of Lp(a).

Enantiomeric composition of α-pinene affects catches of bark and wood boring beetles, and associated species, in ethanol-baited multiple-funnel traps.

In 2009, we determined the effects of the enantiomeric composition of the kairomone, α-pinene, on trap catches of arboreal beetles (Coleoptera) in stands of eastern pine trees with resin dominated by (+)-α-pinene. We hypothesized that the responses of beetles would correlate with the predominant enantiomer of α-pinene found in host pines. Lures of (+)-, racemic (±), and (-)-α-pinene were added separately to ethanol-baited multiple-funnel traps. Species such as Monarthrum mali (Fitch), Dendroctonus terebrans (Olivier), Ips grandicollis (Eichhoff), and Pachylobius picivorus (Germar) (Coleoptera: Curculionidae) showed a preference for traps co-baited with (-)-α-pinene. α-Pinene enhanced attraction of Hylastes salebrosus Eichhoff, Hylastes porculus Erickson and Hylastes tenuis Eichhoff (Coleoptera: Curculionidae) to ethanol-baited traps with no effects from enantiomeric composition of α-pinene. The attraction of the ambrosia beetles, Xyleborinus saxesenii (Ratzeburg) and Dryoxylon onoharaense (Murayama) (Coleoptera: Curculionidae) to ethanol-baited traps was interrupted by the addition of α-pinene, regardless of enantiomeric composition. Species such as Xylosandrus germanus (Blandford), Cnestus mutilatus (Blandford) and Stenoscelis brevis (Boheman) (Coleoptera: Curculionidae) were unaffected by the presence of α-pinene. Trap catches of some species of longhorn beetles and bark beetle predators (Coleoptera: Cerambycidae, Cleridae, Elateridae, Histeridae, and Trogossitidae) were increased by the addition of α-pinene, although results varied by location. Platysoma spp. (Coleoptera: Histeridae) showed a marked preference for traps co-baited with (+)-α-pinene in Florida and Georgia. In summary, we found that the enantiomeric composition of α-pinene in hosts was not a good predictor of enantiomeric preferences by beetles.