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Previous recreational cold exposure does not alter endothelial function or sensory thermal thresholds in the hands or feet

New Findings

What is the central question of this study?

Does recreational cold exposure result in cold sensitivity and is this associated with endothelial dysfunction and impaired sensory thermal thresholds?

What is the main finding and its importance?

Previous cold exposure was correlated with foot cold sensitivity which may indicate the development of a subclinical non‐freezing cold injury. Endothelial function and thermal detection were not impaired in cold sensitive individuals therefore further research is required to understand the pathophysiology of subclinical and clinical forms of non‐freezing cold injury.

Abstract
This study investigated whether cold sensitive (CS) individuals, who rewarm more slowly following a mild cold challenge, have impaired endothelial function and sensory thermal thresholds (STT) and whether this was related to reported cold exposure. Twenty seven participants with varying previous cold exposure undertook three tests: STT: warm and cold STT of the fingers and dorsal foot. Endothelial function: measurement of cutaneous vascular conductance (CVC) during iontophoresis of acetylcholine on the forearm, finger and foot. CS test: involving immersion of a foot for 2 minutes in 15°C water followed by 10 minutes of rewarming in 30°C air. Toe skin temperature (Tsk) measured during the CS test was used to form a CS group ( 32°C; n = 9 [4 women] for both groups). A moderate relationship was found between cold exposure ranking and Tsk rewarming (r = 0.408, P = 0.035, n = 27) but not STT or endothelial function. Tsk and blood flow were lower in CS compared to CONTROL before and after foot immersion (Tsk, mean [sd]: 30.3 [0.9]°C v 34.8 [0.8]°C; 27.9 [0.8]°C v 34.3 [0.8]°C; P 

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Anatomic variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus

Abstract

Introduction
This study investigated morphological variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus based on the existence of the intrathoracic nerves and the rami communicantes.

Materials and Methods
Fifty thoracic sympathetic trunks from 26 Korean adult cadavers were used.

Results
The first intrathoracic nerve connecting the first and second thoracic nerves was observed on 36 sides (72%), and the second intrathoracic nerve connecting the second and third thoracic nerves was found on 3 sides (6%). There were either one (62%) or two (10%) first intrathoracic nerves, and only one second intrathoracic nerve (6%). The neural connections of the second and third thoracic sympathetic ganglia to the first thoracic nerve were classified into three types based on the existence of the intrathoracic nerves: type I (68%) had only the first intrathoracic nerve, type II (26%) had no intrathoracic nerve, and type III (6%) had both the first and second intrathoracic nerves. Types I, II, and III were further subdivided into ten, six, and three types, respectively, according to the types of the rami communicantes arising from the second and third thoracic sympathetic ganglia.

Conclusions
Improved knowledge of the variations in intrathoracic nerves and upper thoracic sympathetic ganglia will be helpful to thoracic surgeons when they are disrupting the sympathetic supply to the hand for treating palmar hyperhidrosis, and contribute to successful diagnoses and treatments.

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Topographic Computer Analysis for Acne Scar Treatment on Face accompanying Biopsy Study after Dermal Injection of Hydrotoxin Mixture

Abstract

Background
Acne during youth can leave permanent facial scarring. The depressed acne scars can be treated by injection of stabilized hyaluronic acid (S‐HA) into the dermis. Due to the large number of acne scars, manual injection methods are technically difficult, and bear high risk of lump formation in the dermis. Therefore, the author designed a specific injection method to solve the two abovementioned problems.

Materials/Methods
102 Patients who suffered from acne scars were treated with a mixture of S‐HA (Restylane Vital®) and abobotulinumtoxinA (Dysport®). Using an automatic injector, microdroplets of the mixture (0.001cc of S‐HA and 0.125 U abobotulinumtoxinA) were delivered into 1000 intradermal sites on whole face except eyelids. This instrument radically reduced injection amounts per site (0.001cc), lessened manual operator efforts, and ensured consistent injection depth (from 0.8mm to 1.2mm depending on individual dermal thickness) into the facial dermis. The changes in each depression site of acne scars were evaluated by topographical computer analysis (point‐roughness), based on the 40 magnification microscopic photos generated. Depth measurements of each small acne scar point were taken one by one at the exact same point before and after the treatments. Global Aesthetic Improvement Scale (GAIS) was measured for improvement of acne scars at 1 and 6 months post‐treatment. Additionally, serial histologic examinations of the biopsy specimens evaluated neocollagenesis, neoelastinogenesis, and longevity state of the S‐HA.

Results
78 patients showed improvements of depressed acne scars in physical examinations, medical photos, and dermascopic photos.
Using topographic computer analysis, the average point‐roughness decreased 27.48 % (at 1‐month) from 29.042±6.85 (baseline) to 21.05±6.30 µm (P

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Which dermatology patients attend to Dermatology Outpatient Clinics during the SARS‐CoV‐2 outbreak in Turkey and what happened to them?

ABSTRACT
Coronavirus disease, first emerged in Wuhan, rapidly spread all over the world since December 2019. There are concerns about elective dermatology appointments and its results. Herein, we aimed to find out which type of dermatologic patients attended to dermatology outpatient clinic. The patients visiting the clinics for elective dermatologic diseases between March 11 and 18, 2020, were included in this study. Their age, sex, diagnosis of disease, requirement for emergent intervention, and their medical records about COVID‐19 were obtained. There were 390 patients attending to the dermatology outpatient clinic in this period. The most common disease was acne (N: 94, 24%), only 19% of patients need emergent interventions or dose adjustment. There were 40 (10%) patients over the age of 65. After their visits, five patients were diagnosed as COVID‐19 in 2weeks. Dermatologic examinations may be a vector for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission since being closed to the patient. Five of our patients were diagnosed as COVID‐19 after their elective visit to hospital. Since the asymptomatic course of some young patients, most of our patients were not screened for COVID‐19. Our findings support the concerns of elective physician examinations.
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Modifications to the PREEMPT Protocol for OnabotulinumtoxinA Injections for Chronic Migraine in Clinical Practice

Objective
To assess the PREEMPT protocol modifications that have developed in clinical practice over time.

Background
The United States Food and Drug Administration approved the 155‐unit fixed‐dose, fixed‐site PREEMPT protocol of onabotulinumtoxinA (BoNT‐A) injections for migraine prevention 9 years ago.

Methods
This is an anonymous survey with free text response options of Headache Medicine clinicians.

Results
Out of the 878 contacted Headache Medicine clinicians, 182 (20.7%) completed the survey. Of the 182 respondents, 141 (77.5%) reported that they did not always follow the PREEMPT protocol. Of the 182 respondents, 128 (70%) changed the number of injections, 115 (63%) changed the total units of BoNT‐A injected, 105 (57.7%) altered the location of injection sites (58%); 101 (55.5%) do not aspirate to ensure the absence of blood return; 22 (12.1%) changed the dilution; and 4 (2.2%) added lidocaine. The main reported reasons for changes in number, dose, and location of injections included adapting to the patients’ pain, anatomy, and preferences.

Conclusions
The wide inter‐ and intra‐personal variations in BoNT‐A injections for chronic migraine prevention seen in this survey raise concerns about the standardization of the procedure and suggest that an advisory protocol containing more evidence and discussion of the reasoning behind the recommendations might be more helpful than the current prescriptive protocol.

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Challenges of COVID‐19 pandemic for dermatology

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a new coronavirus responsible for the pandemic named coronavirus disease 2019 (COVID‐19). The disease causes SARS with a significant morbidity and mortality. We provide a review with a focus on COVID‐19 in dermatology. We discuss triage of suspected infectious patients, protection of medical doctors and nurses. We discuss the available data on cutaneous symptoms, although disease‐specific symptoms have yet not been observed. COVID‐19 is a challenge for the treatment of dermatologic patients, either with severe inflammatory disorders or with skin cancer. The consequences for systemic treatment are obvious but it will be most important to collect the clinical data for a better decision process. Last but not least, education in dermatology for students will not be temporarily possible in the classical settings. COVID‐19, although not a skin disease, by itself has an immense impact on dermatology.
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Overall safety of relamorelin in adults with diabetic gastroparesis: Analysis of phase 2a and 2b trial data

Summary

Background
Relamorelin, a pentapeptide ghrelin receptor agonist, accelerated gastric emptying significantly and improved symptoms in adults with diabetic gastroparesis in phase 2 trials.

Aim
To assess the safety and tolerability of relamorelin across phase 2 trials.

Methods
Safety assessments in patients aged 18‐75 years (weight, adverse events [AEs] and laboratory tests) from two randomised, double‐blind phase 2 trials (NCT01571297, NCT02357420; results published previously) were reviewed descriptively. Analysis of covariance assessed treatment effect on glycated haemoglobin (HbA1c) and blood glucose post hoc. Phase 2a and 2b trial durations were, respectively, 4 weeks (relamorelin 10 µg once or twice daily [b.d.] or placebo b.d.) and 12 weeks (relamorelin 10, 30 or 100 µg or placebo b.d.) with 1‐ and 2‐week, single‐blind placebo run‐ins.

Results
Among 204 phase 2a and 393 phase 2b patients, respectively, 67% and 62% were female, and 88% and 89% had type 2 diabetes. Proportions of patients reporting serious AEs were similar across treatment groups, as were those with ≥1 treatment‐emergent AE (TEAE). TEAE‐related discontinuations were proportionally higher in relamorelin groups than placebo. Of 12 serious TEAEs in phase 2a, none occurred in >1 patient. In phase 2b, five serious TEAEs were reported in >1 patient, and one (100 µg) died (urosepsis), all unrelated to relamorelin. In phase 2b, increased HbA1c and fasting blood glucose levels were dose‐related (P