May 13, 2016

Skin shift

The story

The old way to see fewer bags under your eyes was to call in sick for your 27-hour shift. Count on modern science for innovative solutions.

The product

'Second skin' is an elastic, wearable cross-linked polymer. It's applied in two-parts: first through a silicone and oxygen cream, and then a catalyst is added to cross-link the polymer and make it stronger. The polymer was designed to closely match the elastic recoil and tension of normal human skin. Beyond obvious cosmetic uses, the designers see it as a futuristic sunscreen and a treatment for several chronic skin disorders.

The results

In a proof-of-concept study of 170 patients, second skin decreased the appearance of lower eyelid bags (or fat pad herniation) by 2 levels on a 5-point visualization scale. Photos and videos are striking, and no ill effects or allergic reactions have been reported thus far. Given the early nature of the study, the product is a ways away from FDA approval and subsequent marketing.
Nature Materials

The takeaway

Besides freshening up your summer look, the skin could help treat a host of skin conditions, including eczema and psoriasis. But a lot of further research would need to take place first. Stay tuned.

Say it on rounds

When you can't think straight after working overnight

Something's wrong, even if doesn't show up on diagnostic tests. The same goes for smoking and COPD, where an observational study found that respiratory symptoms, as measured by the CAT (COPD assessment test) instrument, were common despite preserved pulmonary function tests (PFTs). Current or former smokers with preserved PFTs and high CAT scores were more likely than those with lower CAT scores to have respiratory exacerbations, activity limitation and airway-wall thickening on CT imaging. The results call into question the use of spirometry in smokers to diagnose and assess COPD.

When you think a lot of people are on statins

Oral contraceptive pills have over 100 million users worldwide, but they increase the risk of pulmonary embolism, MI, and ischemic stroke. A French epidemiology study pooled over 5 million pieces of data from hospital discharge and insurance databases to look at optimal estrogen dosing and progesterone type for combination pills. The winning combination – low-dose estrogen (20 micrograms) and levonorgestrol – was associated with fewer PEs than other formulations. 

When your patient panics at the word 'treadmill'

Time for a sedentary stress test. In a single-center observational study, cardiac MRI (CMR) was a stronger predictor of future cardiac events than the tried and true nuclear stress test (SPECT myocaridal perfusion imaging) in a 5-year analysis. Advocates for CMR say the procedure can better identify coronary disease and is more cost-effective than SPECT.

Brush up

Rheumatoid arthritis (RA)

RA is an inflammatory joint disease with systemic manifestations. Look for a clinical history of morning stiffness and symmetric polyarthritis of small joints on physical exam. Factors that contribute to disease classification score include swollen joints, serologies for rheumatoid factor and anti-citrullinated protein antibody, lab markers of inflammation, and duration of symptoms > 6 weeks.

Treat to target

Choose an RA treatment agent based on regular assessment of clinical disease activity with a score such as CDAI or SDAI. Start with methotrexate and consider an initial dose of glucocorticoids. If remission is not achieved in 3 - 6 months, switch therapies. Use a biologic agent (TNF inhibitor, IL-6 inhibitor, T-cell costimulation block, JAK inhibitor, or B-cell inhibitor) when disease activity is high in the setting of methotrexate failure

Food wars

The FDA scolded the CEO of Kind Bar for calling his snacks 'healthy' last year. Now the agency is reconsidering its guidelines for food labeling in nut products.

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