Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Practice and Educational Gaps in Light, Laser, and Energy Treatments

This article discusses current practice in laser dermatology, the gaps in practice, and recommendations for improvement. As is the case with other areas of cosmetic dermatology, there is a rapid development of new laser and light devices with limited epidemiologic data available to inform best practice. The high fixed cost associated with new laser devices, limited space available in some practices, and inconsistent training may limit the adoption of needed therapies. Improving research in this area; training opportunities for physicians, residents, and staff; and cost-effective laser/light device rentals programs could improve quality of current practice

Assessing Skin Biopsy Rates for Histologic Findings Indicative of Nonpathological Cutaneous Disease

BACKGROUNDRecent increase in skin biopsies has been attributed to an epidemic of skin cancer. This may be avoidable, with potential savings.OBJECTIVETo determine whether the increase in skin biopsies is attributable to increasing frequency of biopsies associated with histology lacking pathological cutaneous disease. Pathological cutaneous disease was defined as (1) a malignancy, precancerous lesion, or lesion of uncertain behavior; or (2) disease symptomatic or associated with adverse quality of life impact.PATIENTS AND METHODSRetrospective cohort study, 2006 to 2013 of dermatology practice serving Florida and Ohio. Data were a consecutive sample of skin biopsies for diagnosis of dermatologic disease.RESULTSA total of 267,706 biopsies by an average of 52 providers per month from January 06 to December 13 were analyzed. Number of biopsies per visit increased 2% per year (RR: 1.02, CI: 1.00-1.04). Likelihood of biopsy associated with histology indicative of nonpathological cutaneous disease did not increase over time (OR: 0.99, CI: 0.95-1.03, p =.6302).CONCLUSIONRates of biopsies associated with nonpathological cutaneous disease is not increasing. Overall biopsy rates per visit have gradually increased; this seems attributable to greater rates of detection of pathological dermatologic disease

Deployment of TREND : a low-noise receiver user instrument at 1.25 THz to 1.5 THz for AST/RO at the South Pole

We have developed and constructed a low noise receiver user instrument based on HEB technology. TREND (Terahertz REceiver with NbN HEB Device). The plan was to install TREND on the 1.7 meter diameter AST RO submillimeter wave telescope at the Amundsen/Scott South Pole Station during the austral summer season of 2002/2003. The frequency range of 1.25 THz to 1.5 THz was chosen in order to match the best windows for atmospheric transmission and interstellar spectral lines of special interest. The South Pole Station is the best available site for ground-based THz observations due to the very cold and dry atmosphere over this site. The TREND team is now able to report that this receiver has been installed on schedule and met our goals for its performance. TREND is thus ready to perform astronomical observations in the upcoming austral winter season as soon as the weather becomes suitable for THz work. The first spectral lines which will be observed are the CO J = 11￫10 line at 1.27 THz and the 1.46 THz line of NII. TREND is an NbN Hot Electron Bolometer (HEB) type receiver and the double sideband noise temperature at 1.27 THz has been measured on the telescope to be 1.200 K. The local oscillator is a CO2 laser pumped amplitude stabilized CD30H gas laser. The TREND receiver will pioneer observations from a ground-based telescope at frequencies well above 1 THz. This is also the first time that a receiver can potentially perform an extensive study of the ubiquitous Nil ion, first noted by COBE

Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations

Importance: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. Objective: To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. Evidence Review: A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. Findings: Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. Conclusions and Relevance: Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions