5 research outputs found
Comfort positioning during procedures in pediatric dermatology
Procedures performed in pediatric dermatology can often be painful or distressing for patients and their families. Comfort positioning, which involves sitting the child upright, immobilized and held by a caretaker, is one strategy that may be employed in this setting; this measure has been shown to reduce patient distress, improve cooperation and give caretakers a more active role in the procedure. We demonstrate several positions of comfort for dermatologic procedures involving the arm, cheek, back and leg of a young child
The Human Cell Atlas White Paper
The Human Cell Atlas (HCA) will be made up of comprehensive reference maps of
all human cells - the fundamental units of life - as a basis for understanding
fundamental human biological processes and diagnosing, monitoring, and treating
disease. It will help scientists understand how genetic variants impact disease
risk, define drug toxicities, discover better therapies, and advance
regenerative medicine. A resource of such ambition and scale should be built in
stages, increasing in size, breadth, and resolution as technologies develop and
understanding deepens. We will therefore pursue Phase 1 as a suite of flagship
projects in key tissues, systems, and organs. We will bring together experts in
biology, medicine, genomics, technology development and computation (including
data analysis, software engineering, and visualization). We will also need
standardized experimental and computational methods that will allow us to
compare diverse cell and tissue types - and samples across human communities -
in consistent ways, ensuring that the resulting resource is truly global.
This document, the first version of the HCA White Paper, was written by
experts in the field with feedback and suggestions from the HCA community,
gathered during recent international meetings. The White Paper, released at the
close of this yearlong planning process, will be a living document that evolves
as the HCA community provides additional feedback, as technological and
computational advances are made, and as lessons are learned during the
construction of the atlas
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Vaccine considerations for adult dermatology patients on immunosuppressive and immunomodulatory therapies: a clinical review
Adults with chronic inflammatory skin disease are at increased risk of vaccine-preventable illnesses and infections, likely because of the underlying disease itself and also their treatment with immunosuppressive and immunomodulatory medications. Despite the association between these agents and increased susceptibility to infection, vaccination rates in dermatology patients remain low. Although preventative care such as vaccinations is typically managed by primary care providers, dermatologists serve a critical role in spreading awareness of the specific risks of immunosuppressive and immunomodulatory agents and promoting understanding of individualized vaccine recommendations. In this review, we provide evidence-based information on vaccine recommendations for adult dermatology patients, specific to age and medication use
Synthesis and Evaluation of a Novel Bivalent Selective Antagonist for the Mu-Delta Opioid Receptor Heterodimer that Reduces Morphine Withdrawal in Mice
A major
limitation in the study of the mu-delta opioid receptor
heterodimer (MDOR) is that few selective pharmacological tools exist
and no heteromer-selective antagonists. We thus designed a series
of variable-length (15–41 atoms) bivalent linked peptides with
selective but moderate/low-affinity pharmacophores for the mu and
delta opioid receptors. We observed a U-shaped MDOR potency/affinity
profile in vitro, with the 24-atom spacer length (<b>D24M</b>) producing the highest MDOR potency/affinity (<1 nM) and selectivity
(≥89-fold). We further evaluated <b>D24M</b> in mice
and observed that <b>D24M</b> dose-dependently antagonized tail
flick antinociception produced by the MDOR agonists CYM51010 and Deltorphin-II,
without antagonizing the monomer agonists DAMGO and DSLET. We also
observed that <b>D24M</b> sharply reduced withdrawal behavior
in models of acute and chronic morphine dependence. These findings
suggest that <b>D24M</b> is a first-in-class high-potency MDOR-selective
antagonist both in vitro and in vivo
Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma
Importance: Ulceration is a common complication of infantile hemangioma (IH), which leads to substantial morbidity. Ulceration in IH has not been systematically studied since the advent of β-blocker therapy for IH.
Objectives: To examine treatment interventions used for ulceration in IH and identify clinical prognostic indicators of healing time.
Design, setting, and participants: A retrospective, multicenter cohort study was conducted on 436 consecutive patients with a clinical diagnosis of ulcerated IH and available clinical photographs. Patients receiving care at tertiary referral centers evaluated between 2012 and 2016 were included; statistical and data analysis were performed from February 7 to April 27, 2020.
Exposures: Clinical characteristics, treatment interventions, course, complications, and resource use were analyzed. Treatment interventions for ulceration in IH included local (wound care, topical), systemic (β-blocker, corticosteroids), and procedural (pulsed-dye laser).
Main outcomes and measures: The primary end point was time to complete or nearly complete ulceration healing. Clinical characteristics were analyzed to determine the responses to most common interventions and prognostic factors for healing of ulceration.
Results: Of the 436 patients included in the study, 327 were girls (75.0%); median age at ulceration was 13.7 weeks (interquartile range, 8.86-21.30 weeks). The median heal time was 4.79 weeks (95% CI, 3.71-5.86 weeks) with wound care alone, 5.14 weeks (95% CI, 4.57-6.00 weeks) with timolol, 6.36 weeks (95% CI, 5.57-8.00 weeks) with a systemic β-blocker, and 7.71 weeks (95% CI, 6.71-10.14 weeks) with multimodal therapy. After adjusting for IH size, a dose of propranolol less than or equal to 1 mg/kg/d was associated with shorter healing time compared with higher propranolol doses (hazard ratio, 2.04; 95% CI, 1.11 to 3.73; P = .02). Size of the IH was identified as a significant prognostic factor for healing time in multivariable analysis. Increasing size of IH portends a proportionately longer time to heal of the ulceration.
Conclusions and relevance: Despite the use of β-blockers, this cohort study found that a subset of patients with IH ulceration continued to experience prolonged IH healing times. Larger IH size appears to be a poor prognostic factor for time to heal. For patients requiring systemic therapy, initiation of propranolol at lower doses (≤1 mg/kg/d) should be considered