Biological depletion of neutrophils attenuates pro-inflammatory markers and the development of the psoriatic phenotype in a murine model of psoriasis.

Although neutrophils are considered a histologic hallmark of psoriasis, their pathophysiologic role in psoriasis remains unclear. We characterized the effects of neutrophil depletion via injection of monoclonal antibody 1A8 on the development of imiquimod (IMQ)-induced psoriatic lesions in a murine model. Lesions were followed with photographs and histologic analysis, revealing reduced psoriasiform scale and epidermal hyperplasia in neutrophil-depleted. ELISA and flow cytometry were used to determine relative levels of cytokines and immune cells. Compared to controls, IMQ-treated neutropenic mice had significantly lower levels of macrophages in tissue samples (P < .05) and displayed significantly lower numbers of CD4+ T-cells (P < .05). Neutropenic animals exhibited lower levels of TNF-α, IFN-γ, and IL-1ß than controls (P < .05). These results show that neutropenia reduces the development of psoriasiform skin lesions and substantially decreases infiltration of pro-inflammatory cytokines and immune cells to IMQ-induced cutaneous lesions, suggesting an active role of neutrophils in maintaining inflammation in psoriasis.

Systemic therapies in psoriasis: an update on newly approved and pipeline biologics and oral treatments.

Although there are numerous biologics and several oral treatments for psoriasis, a number of promising systemic therapies are on the horizon. Knowledge of these medications might help guide our treatment approach to the patient with psoriasis. This article provides an update on the most recent (as of 2019) approved therapies and medications in the pipeline for moderate to severe plaque psoriasis, with a focus on systemic agents in phase 3 clinical trials.

Autoinflammatory Disorders: A Review and Update on Pathogenesis and Treatment.

The autoinflammatory diseases comprise a broad spectrum of disorders characterized by unchecked activation of the innate immune system. Whereas aberrations in adaptive immunity have long been identified in 'autoimmune' disorders, the concept of 'autoinflammation' emerged relatively recently, first describing a group of clinical disorders characterized by spontaneous episodes of systemic inflammation without manifestations typical of autoimmune disorders. Improved knowledge of innate immune mechanisms, coupled with remarkable progress in genomics and an expanding number of clinical cases, has since led to an increasing number of disorders classified as autoinflammatory or containing an autoinflammatory component. Biologic therapies targeting specific components of the innate immune system have provided immense clinical benefit, and have further elucidated the role of innate immunity in autoinflammatory disorders. This article reviews the basic mechanisms of autoinflammation, followed by an update on the pathophysiology and treatment of the monogenic and multifactorial autoinflammatory diseases, and the common dermatologic conditions in which autoinflammation plays a major role.

Cataract surgery practices in the United States Veterans Health Administration.

PURPOSE: To describe current cataract surgery practices within the United States Veterans Health Administration (VHA). SETTING: Veterans Health Administration hospitals in the U.S. DESIGN: Retrospective data analysis. METHODS: An initial e-mail containing a link to an anonymous 32-question survey of cataract surgery practices was sent to participants in May 2016. Two reminder e-mails were sent to nonresponders 1 week and 2 weeks after the initial survey was sent; the remaining nonresponders were called twice over a 2-week period. The data were analyzed using descriptive statistics. RESULTS: The response rate was 75% (67/89). Cataract surgeons routinely ordered preoperative testing in 29 (45%) of 65 sections and preoperative consultations in 26 (39%) of 66 sections. In 22 (33%) of 66 sections, cataract surgeons administered intracameral antibiotics. In 61 (92%) of 66 sections, cataract surgeons used toric intraocular lenses (IOLs). In 20 (30%) of 66 sections, cataract surgeons used multifocal IOLs. Cataract surgeons in 6 (9%) of 66 sections performed femtosecond laser-assisted cataract surgery. In 6 (9%) of 66 sections, cataract surgeons performed immediate sequential bilateral cataract surgery. Forty-nine (74%) ophthalmology chiefs reported a high level of satisfaction with Veterans Affairs ophthalmology. CONCLUSIONS: The survey results indicate that in cataract surgery in the VHA, routine preoperative testing is commonly performed and emerging practices, such as femtosecond laser-assisted cataract surgery and immediate sequential bilateral cataract surgery, have limited roles. The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings.

Scholarly concentration programs and medical student research productivity: a systematic review.

INTRODUCTION: Scholarly concentration programs have become a common method to promote student inquiry and independent research in medical schools. Given the high resource requirements of scholarly concentration program implementation, it is important to examine program efficacy. This systematic review examined the impact of scholarly concentration programs on student research productivity. METHODS: The authors carried out a literature search to find articles related to scholarly concentration program research productivity outcomes. The inclusion criterion was a method of rigorously evaluating program scholarly productivity. Study rigour was evaluated with the Medical Education Research Study Quality Instrument. RESULTS: The initial search disclosed 2467 unique records: 78 were considered based on titles and abstracts; eight were considered by scanning references. Eleven papers met the inclusion criteria: all were descriptive; none had a priori hypotheses that examined predictors of medical student research productivity in scholarly concentration programs or prospectively evaluated program impact on student scholarly output. DISCUSSION: While few in number and often lacking in rigour, the studies included herein suggest that adequate administrative support, strong mentorship and tailored program characteristics are essential in facilitating student research productivity in scholarly concentration programs. Given the challenges inherent in medical education research, a conceptual framework based on United Way's approach may help program planners and educators address this gap in the evaluation of scholarly concentration programs.

Medical School Ranking and Student Research Opportunities.

OBJECTIVE: This study aimed to characterize the current state of student research opportunities in a sample of US medical schools ranked in three different tiers. METHODS: The authors examined the websites for five US medical schools in each of the first, second, and third tiers per National Institutes of Health funding and U.S. News & World Report rankings. Available research opportunities were identified and categorized. RESULTS: There were 26 schools in the first (n=6), second (n=10), and third (n=10) tiers. From the first, second, and third tiers, 4/6 (67%), 1/10 (10%) and none, respectively, required a research experience (p=0.003); 6/6 (100%), 4/10 (40%) and 1/10 (10%), respectively, offered internally funded one-year research (p=0.002); and 5/6 (83%), 4/10 (40%) and 2/10 (20%), respectively, offered student research days (p=0.045). CONCLUSIONS: Higher ranked schools provided more opportunities for student research by providing internally funded one-year research, requiring research, and offering student research days. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].

Cataract surgery practice patterns in the United States Veterans Health Administration.

To document current cataract surgery practice patterns of ophthalmologists in the United States Veterans Health Administration, an anonymous online 27-question survey was emailed to the 132 members of the Association of Veterans Affairs Ophthalmologists. The results were tabulated in a computerized database and analyzed with descriptive statistics. The response rate was 53% (70/132); 89% (62/70) of the respondents performed cataract surgery. Sixty percent (36/60) of the responding cataract surgeons were full-time employees, and most (85%, 51/60) trained residents. Common practices among them included partial coherence interferometry for biometry (81%, 47/58), topical anesthesia (57%, 33/58), clear corneal incisions (91%, 53/58), and acrylic single-piece intraocular lens (IOL) implantation (97%, 56/58). Eighty-three percent (48/58) offered toric IOLs at their facilities. These results will help benchmark cataract surgery practice patterns in teaching hospitals and facilitate comparison with cataract surgery in other settings.