Dermatology Journals' Editorial Boards Require Improved Gender Equity: JMIR Dermatology's Future Directions

Gender disparities exist across all facets of academic medicine including within the editorial boards of dermatology journals. Only 22% of these editorial boards comprised women, even though 51% of full-time, faculty dermatologists are female. When inviting academic dermatologists to our editorial board at JMIR Dermatology, we invited 50% women to represent the gender distribution of academic dermatologists; however, we have not sufficiently reached gender equity among accepted editorial board members. We will continue to strive toward the goal of gender equity on our editorial board and invite other dermatology journals to do the same.

Diversity, Equity, and Inclusion of Dermatology Journals and Their Editorial Board Members

Dermatology as a whole suffers from minority underrepresentation. We conducted a search of the top 60 dermatology journals for mention of their approach to increasing diversity, equity, and inclusion (DEI) within their publication through editorial board members or peer-review processes. Of those 60, only 5 had DEI statements or editorial board members dedicated to increasing DEI. There are publications with checklists and frameworks for increasing DEI within the literature. We propose that more journals implement these resources within their peer-review process to increase diversity within their publication.

The Relationship Between Autoimmune Disease and Disease-Modifying Antirheumatic Drugs on Wound Healing

Objective: To evaluate the role of disease-modifying antirheumatic drugs (DMARDs) on wound healing outcomes of patients with autoimmune disease at our tertiary wound care center. Approach: Retrospective review of patients presenting to our wound care center between 2014 and 2018 with both chronic wounds and a history of inflammatory disease. Patient demographics, comorbid conditions, and progression to complete wound healing were compared between those taking DMARDs or not at the time of wound onset. The study adheres to the STROBE statement. Results: Fifty-eight patients with a total of 296 wounds were retrospectively reviewed. Patients were taking at least one DMARD at wound onset in 217 (73.3%) of these wounds. The average number of DMARDs at wound onset was 1.5 (standard deviation 1.2). Two hundred ten wounds progressed to heal (70.9%), with a median time to healing of 229.5 days (interquartile range 71.0-490.0). Of the 210 wounds that healed, patients taking at least one DMARD had a significantly shorter time to healing relative to patients who were not on any DMARDs (median 190.5 days vs. 340.0 days, p = 0.0156). Innovation: Characterizing wound healing outcomes at a tertiary hospital with a dedicated wound care center and analyzing the role of DMARDs in wound healing progression. Conclusions: The median time to healing in the studied cohort was 229.5 days, which is much longer than the healing time for noninfected diabetic foot ulcers at our institution. These findings highlight the wound healing challenges posed by underlying autoimmune disease.¹⁰.

Severe irritant reaction following sequential waxing and use of a chemical depilatory cream in an adolescent

A 15-year-old girl presented with leg wounds that were sustained after waxing and subsequent chemical depilation. History revealed prior usage of chemical depilatories without irritation. Given this finding, we suspect that waxing disrupted the epidermal barrier and, therefore, rendered the patient more susceptible to severe irritant contact dermatitis upon depilation. While there are reported cases of irritant contact dermatitis and chemical burns secondary to waxing or depilatory cream use in adults, a literature review found no reported cases of chemical burns in a pediatric patient or adult consequent to using these methods in tandem.

Midterm Results of 58 Fractures of the Coronoid Process of the Ulna and their Concomitant Injuries

BACKGROUND

In general, fractures of the coronoid process are rare and usually occur in combination with additional elbow joint injuries. The treatment of these injuries aims to regain a stable as well as a flexible and loadable joint. Although there is currently little evidence, therapy recommendations remain controversial. Therefore, the aim of this study was to prognostically determine relevant factors for therapy recommendation by analysing a representative patient population of two trans-regional trauma centres.

MATERIAL AND METHODS

Seventy-seven patients with a fracture of the coronoid process were treated within an 8-year period (2001 to 2009). After an average of 48 months (SD 31), treatment outcome of 58 patients (75%) was acquired. The results were statistically analysed.

RESULTS

The average age of the patient was 51.8 years (SD 13.6); 36 were male and 34 had a fracture on the right arm. Applying the fracture types of the coronoid process in accordance with Regan/Morrey, the result was: Type I (19), II (17) and III (22). Further injuries were also detected: 40 radial head fractures, 17 proximal ulnar fractures and 2 fractures of the olecranon. A luxation was detected in 44 of the 58 patients (76%). The patients' average MEPS (Mayo Elbow Performance Score) was 80.6 points (SD 18), with significant differences between the various therapy strategies. Fifteen% of the coronoid process fractures were reconstructable to a limited extent only by means of osteosynthesis. In 33% of the patients, instabilities remained. The average extension/flexion came to 107° (SD 28), and pronation and supination 153° (SD 38).

CONCLUSION

At present, a surgical therapy of ligamentary injuries cannot be statistically justified. A stable osseous reconstruction appears to make more sense. The strongest negative prognostic parameters in our patient population were: therapy with an external fixator, immobilisation for more than 21 days, the occurrence of complications and unstable osteosyntheses on the coronoid process.

Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases

Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82), 104 patients were male (67,1%). Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AO-FAS-Score and radiographs. 92,7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5%) the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63,7 (53-92). Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.

Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases

The methods for ankle arthrodesis differ significantly, probably a sign that no method is clearly superior to others. In the last ten years there is a clear favour toward internal fixation. We retrospectively evaluate the technique and evaluate the clinical long term results of external fixation in a triangular frame.

Physical evaluation of a new technique for X-ray dose reduction: Measurement of signal-to-noise ratio and modulation transfer function in an animal model

Aim of this study was to record objective changes in image quality of optically re-exposed, radiation-reduced X-ray images in comparison to a normally exposed reference image in an animal model. Under investigation is the question if optical re-exposure of conventional, radiation-reduced X-ray images partially or even fully compensates the loss of information caused by underexposure. Dose-reduced, underexposed images were prepared by reducing the mAs product to 50% with constant anode voltage. Reproduction of the image was performed with a 52% decrease in the radiation dose. Comparing different re-exposure times, the optimal time was found to be 60s. These underexposed X-rays were then optically re-exposed for a defined period of time before development. In all X-ray images of the animal model, different osseous structures were defined as regions of interest (ROI) for evaluation of the objective changes in image quality. The density curves were plotted with the two-beamed densitometer. The contrast transfer factors as the function of local frequency were determined from this, which served as the basis for calculating the modulation transfer factor. To establish if X-ray sensitisation by optical re-exposure leads to a change in the sensitometric gradation, the sensitometric curves were determined using a standardized aluminum scale and thermal luminescence dosimetry. In the comparison the lowest correlation with the standard technique film (X-ray 1) was seen in the purely dose-reduced X-ray. In the range of 1.6-3.4Lp/mm, both SNR curves have an identical course. Despite a 52% dose reduction in the re-exposed image, both densitometry curves of the conventional and re-exposed X-ray show an almost identical distribution of the transmittance levels. In conclusion film sensitisation provides a technically simple and inexpensive procedure, which is easily integrated into previous film development processes and considerably reduces the patient radiation exposure as well as clearly improving the image quality.

[Resection and replacement of the cervical esophagus and hypopharynx--an interdisciplinary responsibility for visceral, micro- and ENT surgeons]

From 1984 to 1996, 136 carcinomas of the esophagus and 8 of the hypopharynx were resected using 3 different procedures (94 transmediastinal, 36 transthoracic, 14 cervicoabdominal). The hospital mortality rate for cervicoabdominal resection (0%) is unequivocally lower than that of the transmediastinal (17.1%) or transthoracic (14.3%) methods. The 5-year survival rates are not significantly different (24%, 22%, 17%).

[Pyogenic skin infections of the extremities with vascular involvement. Local vascular reconstruction and systemic therapy concepts]

In a 6-year period, we treated 14 patients with severe groin infections involving the femoral artery following drug injection in addicts. In 13 cases, we used autologous material for arterial reconstruction; in one case of massive bleeding the femoral artery had been embolized. Ten patients were treated with full success, two patients had claudication postoperatively, and in two cases above-knee amputations were necessary.

Differential metabolic effects of energy restriction in dogs using diets varying in fat and fiber content

The role of dietary fat and fiber in energy restriction for the management of obesity was examined. Twelve male castrated dogs were energy restricted for 7 weeks by feeding 60% of their calculated maintenance energy requirements (MER = 1500 kcal/m2/d) for ideal body weight. Six dogs were restricted on a high-fat (35.4 kcal% from fat), low-fiber (2.9% dry matter basis [DMB]) diet while the other six dogs were restricted on a low-fat (24.5 kcal% from fat), high-fiber (27% DMB) diet. Compared with the high-fat, low-fiber diet, energy restriction on the low-fat, high-fiber diet resulted in significantly greater decreases in body fat (1472 +/- 166 vs. 853 +/- 176 g; p < 0.05) and total serum cholesterol concentrations (108.7 +/- 11.3 vs. 51.5 +/- 13.9 mg/dL; p < 0.005). Reductions in body weight (2.86 +/- 0.3 vs. 2.14 +/- 0.3 kg; p < 0.09), and mean arterial blood pressure (17.4 +/- 6.1 vs. 6.7 +/- 2.9 mmHg; p < 0.12) were also greater on the low-fat diet; however, these diet effects did not reach statistical significance. These data suggest that the fat and fiber content of the diet during energy restriction are important factors in the management of obesity.

[Gastrointestinal lymphomas: results of multimodal therapy in 57 patients of one center]

From 1982-1995, 57 patients with primary gastrointestinal lymphoma were treated with a multimodality therapy. Of these patients, 36 were primary operated, 43 were given an isolated or postoperative chemotherapy and 17 were treated with radiation. Primary operated patients have a significantly better chance of relapse-free survival than those only treated conservatively.