Combination treatment of bilateral periocular sebaceous carcinomas with microsatellite instability with neoadjuvant pembrolizumab and Mohs surgery.

This case highlights the successful use of pembrolizumab for neoadjuvant treatment of MMR-deficient sebaceous carcinoma of bilateral eyelids to reduce tumour burden allowing smaller defect post-Mohs surgery and better reconstructive outcome. Microsatellite stability, tumour mutational burden and PD-L1 expression are important prognostic factors to be considered for the use of neoadjuvant pembrolizumab. Further studies are needed to determine if neoadjuvant pembrolizumab consistently improves surgical and cosmetic outcomes and reduces local recurrence and metastasis.

Unmet Needs in Psoriasis Patients.

BACKGROUND: Psoriasis can greatly impact patients' quality of life. The introduction of new treatments has improved treatment outcomes, but treatment gaps may still exist. OBJECTIVE: Identify unmet treatment needs in patients with psoriasis. METHODS: Participants aged 18 years or older, with an Amazon Mechanical Turk account, who reported diagnosis of psoriasis and correctly answered an attention check question were included. Results were analyzed using descriptive and inferential statistics. RESULTS: Of the 417 participants who met study inclusion criteria, 51.1% were female, and 39.3% were 31-40 years of age; 61.2% reported mild, 25.4% moderate, and 13.4% severe psoriasis. Most (74.8%) were currently under treatment; half (51.6%) were mostly or completely satisfied with treatment, while 24.5% were slightly or not at all satisfied. Respondents were most satisfied with topical (59.5%), followed by oral (46%), and injectable treatments (19.9%). Most (78.7%) slightly or strongly felt there should be more cost-effective options. Gaps in current psoriasis treatment options included more affordable topical and oral treatments that work faster and require less frequent use. LIMITATIONS: The use of an English survey and Amazon Mechanical Turk precludes certain populations from this study. Participants were not asked to provide their current form of psoriasis treatment. CONCLUSIONS: Despite advances in psoriasis treatment, there remains a desire for more effective, faster, longer acting, and less costly, more accessible treatments. J Drugs Dermatol. 2022;21(8):839-844. doi:10.36849/JDD.6589.

Abametapir for the Treatment of Head Lice: A Drug Review.

OBJECTIVE: This article reviews the pharmacology, safety, efficacy, and clinical importance of abametapir 0.74% (Xeglyze) for the treatment of head lice. DATA SOURCES: From 2020 to May 2021, a systematic review of the MEDLINE and EMBASE databases was conducted using the terms abametapir, Xeglyze, Ha44, and head lice. Bibliographies, Food and Drug Administration (FDA) drug package inserts, and ClinicalTrials.gov were searched for further information. STUDY SELECTION AND DATA EXTRACTION: All relevant full-text articles in English were considered for inclusion, with a final article date range of 1999 to 2020. DATA SYNTHESIS: Abametapir chelates heavy metal cations and inhibits metalloproteinases critical to louse ova development, hatching, and adult survival. In phase II, abametapir had direct ovicidal activity inhibiting 100% of treated louse eggs from hatching, compared with 64% in the vehicle-treated group. In two identical phase III clinical trials, subjects treated with a single 10-minute application of abametapir had greater treatment success compared with vehicle-treated subjects, with 81.1% success versus 50.9% in study 1 (P = 0.001) and 81.8% versus 47.2% in study 2 (P < 0.001). Abametapir was well tolerated, with only mild adverse effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Abametapir is a newly FDA-approved, single-application treatment for head lice in patients aged 6 months and older. This review highlights the safety and efficacy of abametapir in the treatment of head lice. CONCLUSIONS: In the wake of increasing widespread resistance to first-line treatment options, abametapir offers a safe and effective new treatment option for head lice infestations.

Tumid lupus erythematosus and systemic lupus erythematosus: a rare coexistence.

A patient diagnosed with tumid lupus erythematosus (TLE) was subsequently found to have systemic lupus erythematosus (SLE) after presenting to a tertiary care medical centre with shortness of breath and oedema. In this commentary, we discuss this patient's presentation and the association between TLE and SLE.

Effects of Music Therapy During Total Knee Arthroplasty Under Spinal Anesthesia: A Prospective Randomized Controlled Study.

Purpose Music therapy is an effective non-pharmacologic intervention that is cost-effective, easy to implement, and customize. It has been shown to significantly alleviate anxiety and improve patient satisfaction. In this study, we aimed to compare music therapy to a control (no music) group with respect to sedation requirements, anxiety levels, and patient satisfaction for patients undergoing total knee arthroplasty under spinal anesthesia. Methods In this randomized controlled study, we compared the effect of music therapy in patients ≥ 18 years old. Patients undergoing total knee arthroplasty were screened for the study to rule out any contraindications for spinal anesthesia. Patients were randomized in a 1:1 ratio for either the "music" or "control" group. Both groups were compared for sedation requirements, preoperative and postoperative anxiety levels, and patient satisfaction. Results Subjects in the music group had a statistically significant lower than average State-Trait Anxiety Inventory (STAI)-State baseline score as compared to the control group (music group 31.00 (standard deviation (SD) 1.44), control group 38.04 (SD 2.35); p = 0.01). Postoperative STAI-State-Trait Anxiety Inventory (STAI)-State scores for the music group were lower for the music group than the control group (music group 28.34 (SD 1.64), control group 32.21 (SD 1.56), p= 0.09). STAI-Trait scores were similar pre-operatively, but significantly less post-operatively in the music group (28.14 SD 1.0) as compared to the control group (34.71 SD 2.31); p = 0.01. Propofol dose per kilogram per surgical minute was similar between the two groups (music group 0.05, control group 0.06; p= 0.264). Patient satisfaction scores with their perioperative experience were higher in the music group (p= 0.009). Conclusions Music therapy may be offered as an alternative to traditional anxiolytics intra-operatively. However further studies are warranted to evaluate whether or not music therapy can decrease sedation and anxiolytic medications during surgery. The type and mode of delivery of music also need to be studied to better understand the impact of music therapy. Clinical trial registry: Clinicaltrials.gov # NCT03569397.

Study Design in Neurosurgical Research: Considerations for Observational and Experimental Cohort Studies.

There is inadequate neurosurgical literature discussing appropriate clinical study design. Here, we explore considerations for 2 fundamental study designs of epidemiology: experimental and observational cohort studies, through examples of theoretical yet realistic neurosurgical research questions. By examining 2 common neurosurgical procedures-namely, subdural drains for evacuation of chronic subdural hematoma, and the utility of navigation for placing external ventricular drains-we characterize the framework of cohort study models for clinical research applications.

Nucleosomes are stably evicted from enhancers but not promoters upon induction of certain pro-inflammatory genes in mouse macrophages.

Chromatin is thought to act as a barrier for binding of cis-regulatory transcription factors (TFs) to their sites on DNA and recruitment of the transcriptional machinery. Here we have analyzed changes in nucleosome occupancy at the enhancers as well as at the promoters of three pro-inflammatory genes when they are induced by bacterial lipopolysaccharides (LPS) in primary mouse macrophages. We find that nucleosomes are removed from the distal enhancers of IL12B and IL1A, as well as from the distal and proximal enhancers of IFNB1, and that clearance of enhancers correlates with binding of various cis-regulatory TFs. We further show that for IFNB1 the degree of nucleosome removal correlates well with the level of induction of the gene under different conditions. Surprisingly, we find that nucleosome occupancy at the promoters of IL12B and IL1A does not change significantly when the genes are induced, and that a considerably fraction of the cells is occupied by nucleosomes at any given time. We hypothesize that competing nucleosomes at the promoters of IL12B and IL1A may play a role in limiting the size of transcriptional bursts in individual cells, which may be important for controlling cytokine production in a population of immune cells.

Aluminum flame temperature measurements in solid propellant combustion.

The temperature in an aluminized propellant is determined as a function of height and plume depth from diatomic AlO and thermal emission spectra. Higher in the plume, 305 and 508 mm from the burning surface, measured AlO emission spectra show an average temperature with 1σ errors of 2980 ± 80 K. Lower in the plume, 152 mm from the burning surface, an average AlO emission temperature of 2450 ± 100 K is inferred. The thermal emission analysis yields higher temperatures when using constant emissivity. Particle size effects along the plume are investigated using wavelength-dependent emissivity models.

Measurement and analysis of atomic hydrogen and diatomic molecular AlO, C2, CN, and TiO spectra following laser-induced optical breakdown.

In this work, we present time-resolved measurements of atomic and diatomic spectra following laser-induced optical breakdown. A typical LIBS arrangement is used. Here we operate a Nd:YAG laser at a frequency of 10 Hz at the fundamental wavelength of 1,064 nm. The 14 nsec pulses with anenergy of 190 mJ/pulse are focused to a 50 µm spot size to generate a plasma from optical breakdown or laser ablation in air. The microplasma is imaged onto the entrance slit of a 0.6 m spectrometer, and spectra are recorded using an 1,800 grooves/mm grating an intensified linear diode array and optical multichannel analyzer (OMA) or an ICCD. Of interest are Stark-broadened atomic lines of the hydrogen Balmer series to infer electron density. We also elaborate on temperature measurements from diatomic emission spectra of aluminum monoxide (AlO), carbon (C2), cyanogen (CN), and titanium monoxide (TiO). The experimental procedures include wavelength and sensitivity calibrations. Analysis of the recorded molecular spectra is accomplished by the fitting of data with tabulated line strengths. Furthermore, Monte-Carlo type simulations are performed to estimate the error margins. Time-resolved measurements are essential for the transient plasma commonly encountered in LIBS.

Measurement and analysis of titanium monoxide spectra in laser-induced plasma.

We present results including measurement and analysis of titanium monoxide. Pulsed, nanosecond Nd:YAG laser radiation is used in a typical laser-induced breakdown spectroscopy arrangement to record the spectra. This scheme provides experiments analogous to pulsed laser deposition tactics and allows for time-resolved spectroscopic analysis. The computed spectra are generated from a new, accurate line-strength file that allows us to accurately predict γ (A3Φ→X3Δ) and γ' (B3Π→X3Δ) spectral signatures. We infer temperature on the order of 3600±700 K and 4200±800 K at time delays of 52 and 72 µs, respectively. Current interest in this work includes titania (TiO2) nanoparticle generation for thin film applications.

Analysis of time-resolved superposed atomic hydrogen Balmer lines and molecular diatomic carbon spectra.

We present analysis of superposition spectra following laser-induced breakdown (LIB) of methane. Both hydrogen-beta and hydrogen-gamma lines contain discernible contributions from diatomic carbon emissions for time delays of 1 to 2 µs from pulsed, 8 ns, infrared Nd:YAG laser radiation LIB. Analysis of the atomic lines and molecular C(2) spectra reveal electron and molecular excitation temperatures of typically 13,000 and 5000 K, respectively.