CAPABLE: A Scoring System Utilizing Patient-Reported Measures to Evaluate Patient Experience After Mohs Surgery.

BACKGROUND: Patient experience metrics are gaining prominence in health care. We introduce the CAPABLE survey to assess postoperative experiences of Mohs surgery patients. OBJECTIVE: We sought to determine whether CAPABLE scores aligned with overall patient satisfaction in Mohs surgery. METHODS: This was a cross-sectional, survey-based study of patients presenting for their first postoperative visit after Mohs surgery. The CAPABLE survey included questions on postoperative instructions, activity limitations, pain control, provider accessibility, and bleeding, followed by 2 overall satisfaction questions taken from the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems survey. The pilot study took place at the University of Texas Dell Medical School (DMS), followed by a validation study ( n = 206) at DMS and Oregon Health and Science University (OHSU). We assessed for correlations between CAPABLE scores and overall satisfaction. RESULTS: In the pilot study ( n = 137), overall CAPABLE scores and scores of individual CAPABLE components correlated positively with overall satisfaction.In the multisite validation study ( n = 206) spanning DMS and OHSU, CAPABLE scores correlated positively with overall satisfaction. CONCLUSION: The CAPABLE survey is a concise tool for assessing specific, actionable components of the postoperative patient experience in Mohs surgery, while correlating with overall patient satisfaction.

Successful treatment of recurrent advanced cutaneous squamous cell carcinoma with cemiplimab.

A 90-year-old man presented for evaluation of an incompletely excised squamous cell carcinoma above the right brow, with pathology demonstrating tumor extending to resection margins with perineural invasion. A cord of tumor was noted to extend past the orbital rim and towards the posterior orbit. Mohs excision versus coordinated resection and reconstruction with colleagues in the head and neck surgery and craniofacial plastic surgery departments were considered. Multidisciplinary consensus was to proceed with radical resection in the operating room followed by adjuvant radiation therapy. One year later, the patient presented to our Mohs unit with a 3cm eroded multinodular plaque. Following an in-depth discussion regarding the options of further surgery versus systemic treatment, the patient and his family opted to pursue consultation with a medical oncology consultant to discuss restaging and potential systemic therapy. A PET scan with concurrent CT revealed a hypermetabolic right temporal scalp mass without evidence of bony invasion or extension into the nodal basin. Immunotherapy with cemiplimab was started at a dose of 350mg IV every three weeks. After 7 cycles, the patient demonstrated complete clinical resolution with a repeat PET scan showing interval near resolution of abnormal metabolic activity.

The Use of a Fresh-Tissue Cadaver Model for the Instruction of Dermatological Procedures: A Laboratory Study for Training Medical Students.

BACKGROUND: A realistic model for the instruction of basic dermatologic procedural skills was developed, while simultaneously increasing medical student exposure to the field of dermatology. OBJECTIVE: The primary purpose of the authors' study was to evaluate the utilization of a fresh-tissue cadaver model (FTCM) as a method for the instruction of common dermatologic procedures. The authors' secondary aim was to assess students' perceived clinical skills and overall perception of the field of dermatology after the lab. METHODS: Nineteen first- and second-year medical students were pre- and post-tested on their ability to perform punch and excisional biopsies on a fresh-tissue cadaver. Students were then surveyed on their experience. RESULTS: Assessment of the cognitive knowledge gain and technical skills revealed a statistically significant improvement in all categories (p < .001). An analysis of the survey demonstrated that 78.9% were more interested in selecting dermatology as a career and 63.2% of participants were more likely to refer their future patients to a Mohs surgeon. CONCLUSION: An FTCM is a viable method for the instruction and training of dermatologic procedures. In addition, the authors conclude that an FTCM provides realistic instruction for common dermatologic procedures and enhances medical students' early exposure and interest in the field of dermatology.

Combination repair of nasal ala and nasolabial fold defects following Mohs micrographic surgery.

BACKGROUND: Repair of excisional defects involving the nose and cheek requires thoughtful planning to maintain the natural contour of the anatomical sites and optimize cosmetic outcomes. We aim to demonstrate that a combination repair of defects involving the ala and nasolabial fold with a full-thickness skin graft and a local flap can be used with good cosmesis and minimal complications. METHODS: This is a case report of a patient with skin cancer on the left ala and left nasolabial fold who underwent Mohs micrographic surgery for tumor extirpation. RESULTS: The patient and the Mohs surgeon reported satisfaction with the cosmetic and functional outcomes at the 6-month postoperative follow-up with no complications. CONCLUSION: The use of a full-thickness skin graft from a standing tissue cone and a cheek crescentic advancement flap is a viable repair option for Mohs micrographic surgery defects involving the ala and nasolabial fold.

Oral Gauze for Bleeding Control in Perioral and Perinasal Dermatologic Surgery.

The use of oral gauze is a quick, cheap, and effective method of preventing bleeding into the patient's mouth during dermatologic surgery. We recommend this technique combined with appropriate positioning for lesions in the perioral and perinasal regions. Similar approaches may be applied for the prevention of bleeding into the ear canal during facial/periauricular surgery.

Hemodynamic effects of dexmedetomidine--fentanyl vs. nalbuphine--propofol in plastic surgery.

UNLABELLED: Dexmedetomidine has demonstrated to be useful in several clinical fields due to its respiratory safety and cardiovascular stability. We undertook this study to determine its usefulness in plastic surgery. Sixty patients were divided into two parallel groups. A group received dexmedetomidine--fentanyl and the comparison group received nalbuphine--propofol, both with same dose of midazolam. Blood pressure, heart rate and oxygen saturation were determined during the preoperative, intraoperative and recuperation periods. RESULTS: In both groups, hemodynamic constants decreased intraoperatively. Dexmedetomidine--fentanyl decreased more than in the nalbuphine--propofol (systolic blood pressure, p = 0.006; diastolic blood pressure, p = 0.01 and heart rate, p = 0.007). Comparatively, oxygen saturation was greater in the dexmedetomidine--fentanyl group vs. nalbuphine--propofol (p = 0.0001). Recovery time for the nalbuphine--propofol group was shorter than in the dexmedetomidine--fentanyl group (p = 0.0001). CONCLUSIONS: Dexmedetomidine shows the same cardiovascular stability but with absence of respiratory depression.

Revisiting the East-West advancement flap: great for multiple anatomic locations.

BACKGROUND: The east-west advancement flap is a simple flap traditionally used to repair Mohs surgery defects on the nose. We aim to demonstrate this flap can be used with good cosmetic outcome and minimal complications on a variety of anatomical sites. METHODS: This study was a case series of four patients taking place between March 2021 and September 2021 with 4- to 6-week postoperative follow-up. RESULTS: Four male patients were included in the study. Repair sites included the helix, chin, wrist, and scalp. All patients and the Mohs surgeon reported satisfaction with the cosmetic outcome at 4- to 6-week postoperative follow-up with no complications. CONCLUSION: The east-west advancement flap is a viable repair option for Mohs surgery defects on a variety of anatomical sites.

Effect of thiamine administration on metabolic profile, cytokines and inflammatory markers in drug-naïve patients with type 2 diabetes.

PURPOSE: To evaluate the effect of thiamine administration on metabolic profile, cytokines and inflammatory markers in drug-naïve patients with type 2 diabetes mellitus (T2DM). METHODS: A randomized, double-blind, placebo-controlled, pilot-scale clinical trial was carried out in 24 patients with T2DM. Twelve subjects received thiamine orally (150 mg), once daily during a fasting state for 1 month. An additional 12 patients (control group) were given placebo for the same period of time. Before and after the intervention, fasting glucose, A1C, creatinine, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, very low-density lipoprotein, high-sensitive C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin and adiponectin levels were estimated. Wilcoxon's signed-rank and Mann-Whitney U test were used for statistical analyses. RESULTS: There were significant decreases in glucose (6.7 ± 1.0 mmol/l vs. 6.0 ± 1.0 mmol/l, p = 0.024) before and after the intervention, respectively, and leptin concentrations (32.9 ± 13.3 ng/ml vs. 26.9 ± 12.8 ng/ml, p = 0.027) before and after the intervention, respectively, with thiamine administration. There were no changes with the rest of the measurements. CONCLUSIONS: Thiamine administration for 1 month decreased glucose and leptin concentrations in drug-naïve patients with T2DM.

Photodynamic therapy utilizing 10% ALA nano-emulsion gel and red-light for the treatment of squamous cell carcinoma in-situ on the trunk and extremities: Pilot study and literature update.

BACKGROUND: Data evaluating the effectiveness of photodynamic therapy (PDT) with aminolevulinic acid (ALA) 10% nanoemulsion gel and red-light LED lamp for the treatment of squamous cell carcinoma in situ (SCCis) on the trunk and extremities is limited. Our study sought to investigate the safety and efficacy of utilizing ALA 10% gel with red-light lamp for the treatment of SCCis on the trunk and extremities. METHODS: A single center prospective study of 12 patients with biopsy proven SCCis underwent one or two cycles of red-light PDT with ALA 10 % gel and 3 hours incubation period. Each cycle consisted of two treatments approximately 10 days apart. All participants had a biopsy for histologic evaluation 4 weeks following the last treatment. RESULTS: All patients achieved clinical and histologic clearance following either one or two cycles at the 4-week post treatment follow up period. The majority of lesions were located on the extremities (n=10) with the remainder located on the trunk (n=2). The mean diameter of the lesions was 1.83 cm. Mild pain was noted in patients, with no interruption of treatment. CONCLUSIONS: Our study indicates that ALA 10% gel with a red-light lamp is a safe and effective treatment option for SCCis on the trunk and extremities.

Genomics and epigenomics of axolotl regeneration.

The axolotl (Ambystoma mexicanum) has been a widely studied organism due to its capacity to regenerate most of its cells, tissues and whole-body parts. Since its genome was sequenced, several molecular tools have been developed to study the mechanisms behind this outstanding and extraordinary ability. The complexity of its genome due to its sheer size and the disproportionate expansion of a large number of repetitive elements, may be a key factor at play during tissue remodeling and regeneration mechanisms. Transcriptomic analysis has provided information to identify candidate genes networks and pathways that might define successful or failed tissue regeneration. Nevertheless, the epigenetic machinery that may participate in this phenomenon has largely not been studied. In this review, we outline a broad overview of both genetic and epigenetic molecular processes related to regeneration in axolotl, from the macroscopic to the molecular level. We also explore the epigenetic mechanisms behind regenerative pathways, and its potential importance in future regeneration research. Altogether, understanding the genomics and global regulation in axolotl will be key for elucidating the special biology of this organism and the fantastic phenomenon that is regeneration.

Effect of 2 liquid nutritional supplements for diabetes patients on postprandial glucose, insulin secretion, and insulin sensitivity in healthy individuals.

AIM: To compare the effect of 2 liquid nutritional supplements (Enterex Diabetic and Glucerna SR) designed for the patient with diabetes mellitus on postprandial glucose, insulin secretion, and insulin sensitivity in healthy individuals. PATIENTS AND METHODS: A randomized, double-blind, crossover clinical trial was carried out in 14 healthy, young (average age 21.7+/-2.8 years) volunteers. Each individual received a single administration of 232 kcal in 232 mL of Enterex Diabetic or in 237 mL of Glucerna SR. Three days later, the intervention was crossed using the opposite supplement. At the beginning of each administration and later at 30, 60, 90, and 120 minutes, glucose and insulin concentrations were measured. Triglyceride concentrations were measured at the beginning and at 120 minutes. Area under the curve of glucose and insulin was calculated. First-phase and total insulin secretion, as well as insulin sensitivity, were assessed. RESULTS: Glucose concentration at 120 minutes was significantly lower after the administration of Enterex Diabetic in comparison with Glucerna SR (4.3+/-0.6 vs 4.7+/-0.4 mmol/L; P=.012). Enterex Diabetic compared with Glucerna SR showed a greater change of the glucose concentration from 0 to 120 minutes (-0.7+/-0.6 vs -0.0+/-0.4 mmol/L; P=.002). Administration of Enterex Diabetic decreased insulin concentrations at 120 minutes (60+/-18 vs 48+/-19 pmol/L; P=.013). Administration of Glucerna SR increased triglyceride concentration at 120 minutes (1.0+/-0.3 vs 1.1+/-0.4 mmol/L; P=.026). CONCLUSION: A single administration of Enterex Diabetic in healthy individuals decreased glucose and insulin concentrations at 120 minutes without any modification in triglyceride levels.

Obesity and dyslipidaemia in primary care physicians.

OBJECTIVE: The objective of the study was to identify the prevalence of obesity and dyslipidaemia in primary care physicians. METHODS: A cross-sectional study was carried out in 775 primary care physicians (301 men and 474 women), self-described as healthy. Waist circumference was measured and body mass index was calculated. Glucose concentration and lipid profile (total, low-density lipoprotein and high-density lipoprotein cholesterol levels and triglycerides) were measured. RESULTS: Of 775 physicians, 63.3% were overweight or obese. There were significant differences in waist circumference (P < 0.001), high-density lipoprotein cholesterol (P < 0.001) and triglyceride concentrations (P < 0.001) when the population of physicians was divided in accordance with the body mass index categories. Waist circumference was considered as a risk in 78.9% of physicians. At least one abnormality in the lipid profile was observed in 90.9% of the total subjects studied. Impaired fasting glucose was found in 2.1% of the population. CONCLUSION: In Mexico the prevalence of obesity and dyslipidaemia in primary care physicians was higher than expected.

A Fresh Cadaver Model for the Instruction of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules.

Objective The aim of our study is to determine if a fresh cadaver model (FCM) for the instruction of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules is a practical method for instruction. Study Design Pre- and postinstruction assessment of medical students' ability to perform US-guided FNA of artificially created thyroid nodules placed adjacent to the thyroid gland of a fresh cadaver. Setting University-based fresh cadaver laboratory. Subjects and Methods Study participants included a total of 17 first- and second-year medical students with minimal US training. Technical skills were assessed using a 10-item checklist. In addition, a cognitive assessment regarding the indications, contraindications, and complications of the procedure was completed. A postinstruction assessment was provided for participants 5 weeks after their initial assessment. Differences between pre- and postinstruction assessment scores of technical skills were analyzed using McNemar's test. The mean cognitive knowledge gain was analyzed using a paired 2-sample t test. Results Eight of 10 items on the skills checklist were statistically significant between pre- and postinstruction skills assessment ( P < .05). There was a statistically significant change in cognitive knowledge gain regarding the contraindications of the procedure ( P = .001), but not for indications or complications ( P = .104 and P = .111, respectively). Conclusion US-guided FNA continues to be an important diagnostic procedure in the workup of thyroid nodules, making it an essential skill to integrate into surgical skills lab. Our FCM for the instruction of US-guided FNA is the first of its kind, and this pilot study shows this is a viable method for instruction.