Trends and Differences in Aesthetic Device Industry Interaction Among Dermatologists at the American Society for Laser Medicine and Surgery Conference

OBJECTIVE

Laser and energy-based cosmetic medical device companies are not required to publicly report their interactions with physicians, resulting in limited data on physician-industry relationships in this domain. To gain a better understanding of these relationships, we characterized dermatology-industry interactions at the American Society for Laser Medicine and Surgery (ASLMS) conference, the largest meeting in the field of medical lasers and energy-based devices.

METHODS

Disclosures of all presenters and co-authors were collected for the 2014 and 2018 ASLMS conference programs. Demographic information including gender, fellowship training, and practice setting were obtained and quantified.

RESULTS

There was an increase in disclosures for both male and female dermatologists, 22 percent and 27 percent respectively, between 2014 and 2018, but males still had the greatest overall number of disclosures. The type of interaction varied based on gender with females highest reporting in 2018 being advisory board membership (19%) and males being honoraria (21%).

LIMITATIONS

This study was limited by the inability to assess the monetary value of these interactions and assessment of only ASLMS.

CONCLUSION

There is an increased but differential level of industry interaction among dermatologists between 2014 and 2018, with female dermatologists experiencing the greatest proportional increase.

Lasers, lights, and compounds for melasma in aesthetics

Melasma is a chronic and relapsing skin condition. Although melasma is usually asymptomatic, it can be associated with immense psychosocial stress and greatly impact a patient's quality of life. Over the years, many different treatments have been used, ranging from daily photoprotection, topical lightening creams, and oral agents to laser and light-based therapies; however, efficacy is often limited with such treatments, and there is currently no effective modality to prevent recurrence. Although treatment strategies had originally centered on the use of hydroquinone, newer modalities now include oral tranexamic acid and lasers. We examined previous and ongoing debates related to melasma treatments and have reviewed the current efficacy and safety of available treatments. Critical components essential to the successful management of melasma are the setting of patient expectations and assurance of treatment compliance.

Dermatomyositis, clinically presenting with cutaneous ulcers, with histopathologic evidence of perforating collagenosis

Dermatomyositis is a systemic, autoimmune diseasewith a variety of clinical features that often includemyositis and characteristic cutaneous findings. Asubset of patients with dermatomyositis developcutaneous ulcers, often in the setting of vasculitis orvasculopathy. We present a case of dermatomyositiswith cutaneous ulcers that show perforatingcollagenosis on histopathologic examination.Acquired reactive perforating collagenosistypically occurs in the setting of diabetes mellitus,chronic renal failure, and other pruritic conditions,and this case represents a rare association withdermatomyositis, which may ultimately be helpful inelucidating the pathophysiology of this perforatingdisorder.

EMR documentation of physician-patient communication following genomic counseling for actionable complex disease and pharmacogenomic results

Genomic risk information for potentially actionable complex diseases and pharmacogenomics communicated through genomic counseling (GC) may motivate physicians and patients to take preventive actions. The Ohio State University-Coriell Personalized Medicine Collaborative is a randomized trial to measure the effects of in-person GC on chronic disease patients provided with multiplex results. Nine personalized genomic risk reports were provided to patients through a web portal, and to physicians via electronic medical record (EMR). Active arm participants (98, 39% female) received GC within 1 month of report viewing; control arm subjects (101, 54% female) could access counseling 3-months post-report viewing. We examined whether GC affected documentation of physician-patient communication by reviewing the first clinical note following the patient's GC visit or report upload to the EMR. Multivariable logistic regression modeling estimated the independent effect of GC on physician-patient communication, as intention to treat (ITT) and per protocol (PP), adjusted for physician educational intervention. Counselees in the active arm had more physician-patient communications than control subjects [ITT, odds ratio (OR): 3.76 (95% confidence interval (CI): 1.38-10.22, p < 0.0094); PP, OR: 5.53 (95% CI: 2.20-13.90, p = 0.0017). In conclusion, GC appreciably affected physician-patient communication following receipt of potentially actionable genomic risk information.

Calcium phosphate supplementation increases faecal Lactobacillus spp. in a randomised trial of young adults

The aim of the studies was to determine the effects of calcium carbonate and calcium phosphate supplementation on faecal Lactobacillus spp., with and without a probiotic supplement, in healthy adults. Study 1 comprised of a randomised, double-blind, crossover design; participants (n=15) received 2 capsules/d of 250 mg elemental calcium as calcium carbonate (Ca1) and calcium phosphate (Ca2) each for 2-week periods, with 2-week baseline and washout periods. Study 2 was a randomised, double-blind, crossover design; participants (n=17) received 2 capsules/d of Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011 (probiotic) alone, the probiotic with 2 capsules/d of Ca1, and probiotic with 2 capsules/d of Ca2 each for 2-week periods with 2-week baseline and washout periods. In both studies, stools were collected during the baseline, intervention and washout periods for Lactobacillus spp. quantification and qPCR analyses. Participants completed daily questionnaires of stool frequency and compliance. In Study 1, neither calcium supplement influenced viable counts of resident Lactobacillus spp., genome equivalents of lactic acid bacteria or stool frequency. In Study 2, faecal Lactobacillus spp. counts were significantly enhanced from baseline when the probiotic was administered with Ca2 (4.83±0.30, 5.79±0.31) (P=0.02), but not with Ca1 (4.98±0.31) or with the probiotic alone (5.36±0.31, 5.55±0.29) (not significant). Detection of L. helveticus R0052 and L. rhamnosus R0011 was significantly increased with all treatments, but did not differ among treatments. There were no changes in weekly stool frequency. Calcium phosphate co-administration may increase gastrointestinal survival of orally-administered Lactobacillus spp.

Evaluation of Bacillus subtilis R0179 on gastrointestinal viability and general wellness: a randomised, double-blind, placebo-controlled trial in healthy adults

A probiotic formulation of Enterococcus faecium R0026 and Bacillus subtilis R0179 has been evaluated in previous clinical trials. However, B. subtilis R0179 has not been evaluated as a single probiotic strain or in combination with other strains at doses higher than 0.1×109 cfu. To establish oral dose-response tolerance and gastrointestinal (GI) viability of B. subtilis R0179, a randomised, double-blind, placebo-controlled trial in healthy adults (n=81; 18-50 years old) was conducted. Participants received B. subtilis R0179 at 0.1, 1.0 or 10×109 cfu/capsule/day or placebo for four weeks. General wellness was assessed using a daily questionnaire evaluating GI, cephalic, ear-nose-throat, behavioural, emetic, and epidermal symptoms. GI symptoms were further evaluated using a weekly gastrointestinal symptom rating scale (GSRS). GI transit viability of B. subtilis R0179 was assessed by plating and microbiota analysis by 16S rRNA at baseline, week 4 of the intervention and washout. General wellness and GI function were not affected by oral consumption of B. subtilis R0179 at any dose. Daily questionnaire syndrome scores were not different from baseline and did not exceed a clinically significant score of 1. GSRS syndrome scores were not different from baseline and ranged from 1.1±0.1 to 1.9±0.2. Faecal viable counts of B. subtilis R0179 demonstrated a dose response: the placebo group (1.1±0.1 log10 cfu/g) differed from 0.1×109 (4.6±0.1 log10 cfu/g), 1×109 (5.6±0.1 log10 cfu/g) and 10×109 (6.4±0.1 log10 cfu/g) (P<0.0001). No significant changes in phyla were observed, but sequence reads binned to multiple operational taxonomic units matching closest to Ruminococci increased during probiotic supplementation. B. subtilis R0179 survives passage through the human GI tract and is well tolerated by healthy adults at intakes from 0.1 to 10×109 cfu/day. The trial has been registered at www.clinicaltrials.gov under NCT01802151.

Evaluation of the broiler's ability to adapt to an early moderate deficiency of phosphorus and calcium

We studied the ability of broiler chickens to adapt to early moderate P and Ca deficiencies by evaluating the impact of feeding different concentrations of P and Ca, from 1 to 18 d, on performance, bone characteristics, and nutrient absorption in the grower (Gr) period (18 to 32 d). Two starter (St) diets were fed from 1 to 18 d: a control (C) diet [0.45% nonphytate P (nPP) and 0.9% Ca] and a low (L) diet (0.30% nPP and 0.6% Ca). On d 19, half of the birds fed the St C diet were switched to a Gr C diet (0.40% nPP and 0.8% Ca), and the other half were switched to a Gr L diet (0.30% nPP and 0.6% Ca), whereas those fed the L diet in the St phase were fed the L diet in the Gr phase, resulting in a total of 3 treatments. Broiler chickens fed the St L diet weighed less (P < 0.05) than those fed the St C diet at 18 d; however, by 23 d they had they caught up to the C-C birds, and no BW differences (P > 0.05) were observed at 28 and 32 d. Feeding the St L diet resulted in decreased (P < 0.05) tibia ash at 18 d, but by 32 d their tibia ash was not different from that of birds fed the St C and Gr L diets. Broilers subjected to P and Ca restriction from hatch to 18 d absorbed more P and Ca during all times sampled than birds fed the St C and Gr C diets or those fed the St C and the Gr L diet. These results demonstrated that modern broilers exhibited a high adaptive capacity when they were exposed to early dietary P or Ca restrictions.

Influence of dietary calcium and phytase on phytate phosphorus hydrolysis in broiler chickens

The effect of Ca and phytase on phytate phosphorus (PP) hydrolysis was studied in vitro and in vivo. In vitro, PP hydrolysis by a 3-phytase and a 6-phytase was studied at pH 2.5 and 6.5 with Ca added at levels equivalent to 0, 0.1, 0.2, 0.4, 0.7, or 0.9% of the diet. Irrespective of enzyme, Ca at a level as low as 0.1% reduced (P < 0.05) PP hydrolysis at pH 6.5. To test these effects in vivo, 22-d-old male broilers were fed 1 of 6 diets (10 replicate pens of 4 birds per diet) for 30 h. The experimental design was a 3 x 2 factorial arrangement of 3 phytase treatments (0, 500 U of phytase A/kg of diet, and 500 U of phytase B/kg of diet) and 2 added Ca levels (0 and 0.5% from CaCO3) to a corn-soy basal diet. Adding Ca to the diet resulted in a reduction (P < 0.05) in ileal PP disappearance from 69.2 to 25.4% when the 0 and 0.5% added Ca diets were fed, respectively, and in apparent ileal Ca and P absorption (46.3 to 33.6% and 67.9 to 29.4% when 0 and 0.5% Ca were added, respectively). Inclusion of a 3-phytase improved (P < 0.05) ileal PP disappearance from 25.4 to 58.9% in diets containing 0 and 0.5% added Ca, but the improvement was less pronounced with a 6-phytase. Apparent ileal Ca absorption was improved (P < 0.05) when Ca, phytase, or both were added to the diet.