An increased expression of interleukin-23 has been observed in patients with pyoderma gangrenosum, leading to the use of ustekinumab as a therapeutic option. We report the successful use of ustekinumab in three patients with treatment-resistant pyoderma gangrenosum of varying clinical presentations.
In recent years, emphasis has been put on that medical student should demonstrate pre-practice/pre-registration core procedural skills to ensure patient safety. Nonetheless, the formal teaching and training of basic suturing skills to medical students have received relatively little attention and there is no standard for what should be tested and how. The aim of this study was to develop and validate, using scientific methods, a tool for assessment of medical students' suturing skills, measuring both micro- and macrosurgical qualities.
A tool was constructed and content, construct, concurrent validity, and inter-rater, inter-item, inter-test reliability were tested. Three groups were included: students with no training in suturing skills, students who have had training, plastic surgery.
The results show promising reliability and validity when assessing novice medical students' suturing skills.
Further studies are needed on implementation of the instrument. Moreover, how the instrument can be used to give formative feedback, evaluate if a required standard is met and for curriculum development needs further investigation.
Level of Evidence: Not ratable.
We report the successful treatment of multiple facial milia with manual extraction and tretinoin in a child with orofaciodigital syndrome type 1. Treatment with topical medications may be insufficient in individuals with orofaciodigital syndrome type 1, and pitted scarring is often a sequala. This case demonstrates that manual extraction is well tolerated and effective in the treatment of multiple milia. In addition, clinicians need to be aware of this rare genetic condition, which commonly presents de novo and can lead to significant morbidity if untreated.
In terms of both its physiological effects as well as its impact on flavor perception, ethanol is the defining component of alcoholic beverages. While ethanol's effect on alcoholic beverage systems has been studied across a variety of disciplines, a comprehensive review of the literature is lacking. The aim of this paper is to review the current literature on ethanol's effect on flavor perception.
This paper reviews the literature, exploring ethanol's effects on the areas of physiochemical properties, instrumental measurements of flavor release, and sensory evaluation across a variety of alcoholic beverages including beer, wine, and distilled beverages and how changes in ethanol concentration can affect flavor perception.
Physicochemical properties such as the molecular level structure of water/ethanol matrices are significantly altered as a function of ethanol concentration. Of particular importance to flavor perception is the effect of ethanol on the release of aroma compounds into the headspace of the beverage. Both static and dynamic headspace systems have been studied. In general, increasing the concentration of ethanol decreases the volatile headspace in static systems, while it tends to increase the volatile headspace in dynamic systems. Most importantly, sensory studies have demonstrated that ethanol concentration significantly changes the flavor profile of beverages to the point where sensory panelists are able to identify and articulate these differences.
The current literature demonstrates that ethanol can have a huge impact of flavor release and sensory perception of alcoholic beverages. Additionally monitoring ethanol's effects in systems as close to real life as possible (i.e., dynamic vs static evaluation) is important. Even with the extensive knowledge in the area, there are still many gaps in our understanding of ethanol's effects on the flavor of alcoholic beverages.
Ethanol has been shown to have a tremendous influence on flavor release and subsequent chemosensory perception in alcoholic beverages. Changes in ethanol concentration can affect consumers' perception of alcoholic beverages in terms of aroma, taste, and mouthfeel.
To assess the efficacy and safety of crisaborole ointment, a phosphodiesterase 4 inhibitor, for the treatment of mild or moderate atopic dermatitis (AD) in two phase III studies (AD-301 and AD-302).
Two identically designed multicentre, double-blind randomized controlled trials were conducted in the U.S.A. Participants were randomized 2 : 1 to receive crisaborole or vehicle treatment. In total 47 and 42 investigational centres were identified for AD-301 and AD-302, respectively.
Inclusion criteria were identified as age ≥ 2 years, clinical diagnosis of AD (as per the Hanifin and Rajka criteria), ≥ 5% body surface area involvement, and baseline Investigator's Static Global Assessment (ISGA) mild or moderate. Exclusion criteria included previous use of biologics or systemic corticosteroids (within the last 28 days) or a topical calcineurin inhibitor/corticosteroid (within the last 14 days), and active skin infection.
Participants were instructed to apply the study drug twice daily to all lesions identified at baseline, and all new lesions identified after day 1 (with weekly review of application instructions). Bland emollients were permitted to be used on skin not treated with the study drug.
The primary outcome was defined as ISGA clear or almost clear at day 29, with a 2-grade or more improvement from baseline.
Secondary outcomes included the proportion of patients with an ISGA score of clear or almost clear at day 29, and time to success in ISGA score. Additional outcomes included pruritus severity and signs of AD (erythema, exudation, excoriation, induration/papulation and lichenification), and were measured on a 4-point scale (none, mild, moderate, severe). Adverse events were also recorded.
More participants in the crisaborole-treated group achieved ISGA scores of clear or almost clear with ≥ 2-grade improvement than in the vehicle-treated group (AD-301, 32·8% vs. 25·4%, P = 0·38; AD-302, 31·4% vs. 18·0%, P < 0·001). Greater percentages of clear and almost clear scores were observed in the treatment groups (51·7% vs. 40·6%, P = 0·005; 48·5% vs. 29·7%; P < 0·001), as well as earlier success in ISGA score and improvement in pruritus (P ≤ 0·001). No serious treatment-related adverse events were identified.
Based on the study results, the authors suggest that crisaborole is a safe treatment that improves disease severity, pruritus and clinical signs associated with AD.
Hydrochlorothiazide, one of the most frequently used diuretic and antihypertensive drugs in the United States and Western Europe, is photosensitizing and has previously been linked to lip cancer.
