Letter to the Editor on “Chrysotile and rock wool fibers induce chromosome aberrations and DNA damage in V79 lung fibroblast cells”

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Role of the anesthesiologist-intensivist outside the ICU: opportunity to add value for the hospital or an unnecessary distraction?.

Purpose of review: Given the extremely expensive nature of critical care medicine, it seems logical that intensivists should play an active role in designing efficient systems of care. The true value of intensivists, however, is not well defined. Recent findings: Anesthesiologists have taken key roles in improving patient safety in the operating room. Anesthesia-related mortality rates have decreased from 20 deaths per 100 000 anesthetics in the early 1980s to less than one death per 100 000 currently. Anesthesiologist-intensivists remain rare (less than 5% of certified anesthesiologists), but increasingly play multiple roles within multidisciplinary teams. This review outlines the roles of intensivists in performance improvement, perioperative assessment; sedation services, extracorporeal and mechanical support, and code/rapid response teams. Critical-care physicians, by definition, work in collaborative multispecialty and multidisciplinary teams that make it difficult to isolate each team member's precise contribution to healthcare value. Summary: Anesthesiologist-intensivists working outside their usual environment provide leadership and clinical guidance towards improving patient outcomes. Copyright (C) 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Withdrawal of life-sustaining therapy.

Purpose of review: The aim of this review is to examine literature relating to the withdrawal of life-sustaining therapy (WLST). Recent findings: Discussions regarding end-of-life issues in adults and children are not occurring comprehensively. Discussions relating to the WLST in the pediatric population varies by institution and may vary by race, age, health insurance, diagnosis, and severity of illness. Completing advance directives prior to placement of life-sustaining treatments is not consistent practice. With the WLST, differences in perspectives exist between medical specialties, within one specialty at different levels of training, and in physicians' ethical and psychological responses to the WLST. The timing of WLST appears to be influenced by ICU strain and communication issues. Study outcomes differ regarding the functionally favorable survival of patients who have had WLST. Universal guidelines for the WLST may not address individual patient circumstances. Summary: Discussions of end-of-life issues early in the course of a patient's health care will contribute to the healthcare team's understanding and respect of the patient's wishes. This article addresses the withdrawal of left ventricular assist devices; attending physicians and physicians-in-training perspectives of WLST; do physicians distinguish between withholding and WLST; the timing of WLST; guidelines for the process of WLST; and pediatrics and end-of-life decisions. Copyright (C) 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Traction alopecia: Symptoms and prevention

Traction alopecia is hair loss caused by tight hairstyles. Caught early, it is fully reversible and the hair can regrow. Learn more about treatment.

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Histologic and Clinical Changes in Vulvovaginal Tissue After Treatment With a Transcutaneous Temperature-Controlled Radiofrequency Device.

BACKGROUND: Although transcutaneous temperature-controlled radiofrequency (TTCRF) may effectively treat vulvovaginal laxity (VVL), atrophic vaginitis (AV), orgasmic dysfunction (OD), and stress urinary incontinence (SUI), there is a lack of histopathologic evidence to validate its use. OBJECTIVE: Evaluate clinical and histological changes induced by vulvovaginal TTCRF. MATERIALS AND METHODS: This was a prospective, nonrandomized trial. Ten female subjects with mild-to-moderate VVL, with or without AV, OD, and/or SUI underwent 3 TTCRFs at 4-week intervals. Five subjects underwent pre- and post-treatment biopsies of the labia majora and vaginal canal for histology. Assessments were performed at baseline and Days 10, 30, 60, and 120. RESULTS: Investigator-rated VVL improved significantly from baseline to Day 10, with improvement maintained through Day 120 (p = .001 and .001, respectively). Sexual satisfaction improved significantly by Day 60 (p = .001). Improvement in AV reached significance at Day 120 (p = .048). Although OD and SUI improved steadily, the difference in improvement did not reach statistical significance. Histology revealed that post-treatment increases in collagen, elastin, vascularity, and small nerve fibers. CONCLUSION: Transcutaneous temperature-controlled RF resulted in significant improvements in AV, VVL, and sexual satisfaction with milder improvements in OD and SUI. Post-treatment histology demonstrated neocollagenesis, neoelastogenesis, neoangiogenesis, and the first reported finding of TTCRF-related neurogenesis. (C) 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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A Prospective Study of the Safety and Efficacy of a Microneedle Fractional Radiofrequency System for Global Facial Photoaging in Chinese Patients.

BACKGROUND: Facial photoaging has become a major cosmetic concern, and the microneedle fractional radiofrequency system (MFRS) is a novel method for rejuvenation that combines radiofrequency and microneedles. OBJECTIVE: This study prospectively evaluated the efficacy and safety of an MFRS in the treatment of facial photoaged skin in Chinese patients. MATERIALS AND METHODS: Twenty-seven patients with moderate facial photoaging were recruited and received 3 treatments at 4-week intervals. Blinded clinical assessment was performed by 2 independent dermatologists on a 5-point global photoaging scale (GPS). Patients were also questioned on the extent of improvement of rhytides, skin tightening, and complexion with a 4-point global aesthetic improvement scale (GAIS) and satisfaction based on a 5-point scale. Adverse events and pain scores were also evaluated. RESULTS: Compared with the baseline, there was a significant improvement in facial photoaged skin after 3 treatments, and these positive outcomes were maintained up to the 6-month follow-up, according to the GPS and GAIS scores. Most patients were satisfied with the treatment and reported mild to moderate pain and adverse effects. CONCLUSION: This MFRS is effective for facial skin rejuvenation in Chinese patients. The therapy also seems safe and well tolerated. (C) 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Commentary on Atypical Melanocytic Proliferations.

No abstract available

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