Current state of laparoscopic and robotic surgery

Minimally invasive surgical innovation has exploded in recent times. Currently, conventional laparoscopy is most widely adopted as the costs are relatively low. However, robotics and single port surgery are leading a revolution in surgery for wealthy health-care systems. We explore the historical and contemporary areas of this evolution

Selective Photothermolysis of Cutaneous Pigmentation by Q-switched Nd: YAG Laser Pulses at 1064, 532. and 355nm

Exposure of skin to nanosecond-domain laser pulses affects the pigmentary system by a process called selective photothermolysis, in which melanosomes and pigmented cells are preferentially altered. Due to the broad absorption spectrum of melanin, this effect may occur with wavelengths that penetrate to vastly different depths within tissue, potentially producing different biologic responses. The effects of single near-ultraviolet (355nm), visible (532nm), and near infrared (1064nm) pulses of 10–12nsec duration were determined in guinea pig skin using gross, histologic, and electron microscopic observations. Threshold response in pigmented skin was a transient immediate ash-white discoloration, requiring 0.11, 0.20 and 1.0J/cm2, at 355, 532, and 1064 nm, respectively. At each wavelength, melanosomes were reputed within keratinocytes and melanocytes, with cytoplasmic and nuclear alterations. Delayed epidermal depigmentation occurred, followed by gradual repigmentation. Deep follicular cells were altered only at 532 and 1064 nm, which produced permanent leukotrichia. The action spectrum for threshold response was consistent with mechanisms implied by selective photothermolysis. These data may be useful for consideration of treatment for cutaneous pigmentation abnormalities or unwanted follicular pigmentation, or both

A hybrid approach to conjunctive partial evaluation of logic programs

Conjunctive partial deduction is a well-known technique for the partial evaluation of logic programs. The original formulation follows the so called online approach where all termination decisions are taken on-the-fly. In contrast, offline partial evaluators first analyze the source program and produce an annotated version so that the partial evaluation phase should only follow these annotations to ensure the termination of the process. In this work, we introduce a lightweight approach to conjunctive partial deduction that combines some of the advantages of both online and offline styles of partial evaluation. © 2011 Springer-Verlag.This work has been partially supported by the Spanish Ministerio de Ciencia e Innovación under grant TIN2008-06622-C03-02 and by the Generalitat Valenciana under grant ACOMP/2010/042.Vidal Oriola, GF. (2011). A hybrid approach to conjunctive partial evaluation of logic programs. En Logic-Based Program Synthesis and Transformation. Springer Verlag (Germany). 6564:200-214. https://doi.org/10.1007/978-3-642-20551-4_13S2002146564Ben-Amram, A., Codish, M.: A SAT-Based Approach to Size Change Termination with Global Ranking Functions. In: Ramakrishnan, C.R., Rehof, J. (eds.) TACAS 2008. LNCS, vol. 4963, pp. 218–232. Springer, Heidelberg (2007)Bruynooghe, M., De Schreye, D., Martens, B.: A General Criterion for Avoiding Infinite Unfolding during Partial Deduction of Logic Programs. In: Saraswat, V., Ueda, K. (eds.) Proc. 1991 Int’l Symp. on Logic Programming, pp. 117–131 (1991)Christensen, N.H., Glück, R.: Offline Partial Evaluation Can Be as Accurate as Online Partial Evaluation. ACM Transactions on Programming Languages and Systems 26(1), 191–220 (2004)Codish, M., Taboch, C.: A Semantic Basis for the Termination Analysis of Logic Programs. Journal of Logic Programming 41(1), 103–123 (1999)De Schreye, D., Glück, R., Jørgensen, J., Leuschel, M., Martens, B., Sørensen, M.H.: Conjunctive Partial Deduction: Foundations, Control, Algorihtms, and Experiments. Journal of Logic Programming 41(2&3), 231–277 (1999)Hruza, J., Stepánek, P.: Speedup of logic programs by binarization and partial deduction. TPLP 4(3), 355–380 (2004)Jones, N.D., Gomard, C.K., Sestoft, P.: Partial Evaluation and Automatic Program Generation. Prentice-Hall, Englewood Cliffs (1993)Leuschel, M.: Homeomorphic Embedding for Online Termination of Symbolic Methods. In: Mogensen, T.Æ., Schmidt, D.A., Sudborough, I.H. (eds.) The Essence of Computation. LNCS, vol. 2566, pp. 379–403. Springer, Heidelberg (2002)Leuschel, M.: The DPPD (Dozens of Problems for Partial Deduction) Library of Benchmarks (2007), http://www.ecs.soton.ac.uk/~mal/systems/dppd.htmlLeuschel, M., Elphick, D., Varea, M., Craig, S., Fontaine, M.: The Ecce and Logen Partial Evaluators and Their Web Interfaces. In: Proc. of PEPM 2006, pp. 88–94. IBM Press (2006)Leuschel, M., Vidal, G.: Fast Offline Partial Evaluation of Large Logic Programs. In: Hanus, M. (ed.) LOPSTR 2008. LNCS, vol. 5438, pp. 119–134. Springer, Heidelberg (2009)Lloyd, J.W., Shepherdson, J.C.: Partial Evaluation in Logic Programming. Journal of Logic Programming 11, 217–242 (1991)Somogyi, Z.: A System of Precise Modes for Logic Programs. In: Shapiro, E.Y. (ed.) Proc. of Third Int’l Conf. on Logic Programming, pp. 769–787. The MIT Press, Cambridge (1986

Cold and COVID: Recurrent Pernio during the COVID-19 Pandemic

Pernio is a commonly reported cutaneous manifestation of SARS-CoV-2 infection.(1) Our international registry of COVID-19 dermatologic manifestations has collected 1,176 total cases of COVID-19 skin manifestations, including 619 cases of pernio in suspected or confirmed COVID-19 patients.(1) Most patients with new-onset pernio were entered into the registry after the first pandemic wave (79% in March-May 2020). Starting in September 2020, the registry received reports of a subset of these patients who developed recurrent pernio in the following months

The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries

BACKGROUND: Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations. OBJECTIVE: To characterize the diversity of cutaneous manifestations of COVID-19, and facilitate understanding of underlying pathophysiology. METHODS: Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies. RESULTS: The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, while retiform purpura presented exclusively in ill, hospitalized patients. LIMITATIONS: We cannot estimate incidence or prevalence. Confirmation bias is possible. CONCLUSION: This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were non-specific, while others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology

Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases

BACKGROUND: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. OBJECTIVE: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. METHODS: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. RESULTS: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. LIMITATIONS: Registry analysis does not measure incidence. Morphologic misclassification is possible. CONCLUSIONS: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination

Coronavirus Disease 2019 and Dermatology Practice Changes

The impact of the COVID-19 pandemic on dermatology practice cannot be overstated. At its peak, the pandemic resulted in the temporary closure of ambulatory sites as resources were reallocated towards pandemic response efforts. Many outpatient clinics have since reopened and are beginning to experience a semblance of pre-pandemic routine, albeit with restrictions in place. We provide an overview of how COVID-19 has affected dermatology practice globally beginning with the rise of teledermatology. A summary of expert recommendations that shape the new normal in various domains of dermatology practice, namely, dermatology consultation, procedural dermatology, and phototherapy, is also provided