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Salt and Atopic Dermatitis. 盐与特应性皮炎
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-20 DOI: 10.1001/jamadermatol.2024.4914
Ian A Myles, Jeffrey B Kopp
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引用次数: 0
Salt and Atopic Dermatitis-Reply. 盐与特应性皮炎-回复。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-20 DOI: 10.1001/jamadermatol.2024.4911
Brenda M Chiang, Morgan Ye, Katrina Abuabara
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引用次数: 0
Lowell A. Goldsmith, MD, MPH, 1938-2024-A Personal Remembrance From 3 Friends. 洛厄尔-戈德史密斯(Lowell A. Goldsmith),医学博士,公共卫生硕士,1938-2024-三位好友的个人纪念。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-16 DOI: 10.1001/jamadermatol.2024.5359
Ervin Epstein, Gerald S Lazarus, Luis A Diaz
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引用次数: 0
Skin Cancer Diagnosis by Lesion, Physician, and Examination Type: A Systematic Review and Meta-Analysis. 按病变、医生和检查类型诊断皮肤癌:系统回顾与元分析》。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-13 DOI: 10.1001/jamadermatol.2024.4382
Jennifer Y Chen, Kristen Fernandez, Raj P Fadadu, Rasika Reddy, Mi-Ok Kim, Josephine Tan, Maria L Wei
<p><strong>Importance: </strong>Skin cancer is the most common cancer in the US; accurate detection can minimize morbidity and mortality.</p><p><strong>Objective: </strong>To assess the accuracy of skin cancer diagnosis by lesion type, physician specialty and experience, and physical examination method.</p><p><strong>Data sources: </strong>PubMed, Embase, and Web of Science.</p><p><strong>Study selection: </strong>Cross-sectional and case-control studies, randomized clinical trials, and nonrandomized controlled trials that used dermatologists or primary care physicians (PCPs) to examine keratinocytic and/or melanocytic skin lesions were included.</p><p><strong>Data extraction and synthesis: </strong>Search terms, study objectives, and protocol methods were defined before study initiation. Data extraction was performed by a reviewer, with verification by a second reviewer. A mixed-effects model was used in the data analysis. Data analyses were performed from May 2022 to December 2023.</p><p><strong>Main outcomes and measures: </strong>Meta-analysis of diagnostic accuracy comprised sensitivity and specificity by physician type (primary care physician or dermatologist; experienced or inexperienced) and examination method (in-person clinical examination and/or clinical images vs dermoscopy and/or dermoscopic images).</p><p><strong>Results: </strong>In all, 100 studies were included in the analysis. With experienced dermatologists using clinical examination and clinical images, the sensitivity and specificity for diagnosing keratinocytic carcinomas were 79.0% and 89.1%, respectively; using dermoscopy and dermoscopic images, sensitivity and specificity were 83.7% and 87.4%, and for PCPs, 81.4% and 80.1%. Experienced dermatologists had 2.5-fold higher odds of accurate diagnosis of keratinocytic carcinomas using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. When examining for melanoma using clinical examination and images, sensitivity and specificity were 76.9% and 89.1% for experienced dermatologists, 78.3% and 66.2% for inexperienced dermatologists, and 37.5% and 84.6% for PCPs, respectively; whereas when using dermoscopy and dermoscopic images, sensitivity and specificity were 85.7% and 81.3%, 78.0% and 69.5%, and 49.5% and 91.3%, respectively. Experienced dermatologists had 5.7-fold higher odds of accurate diagnosis of melanoma using dermoscopy compared with clinical examination. Compared with PCPs, experienced dermatologists had 13.3-fold higher odds of accurate diagnosis of melanoma using dermoscopic images.</p><p><strong>Conclusions and relevance: </strong>The findings of this systematic review and meta-analysis indicate that there are significant differences in diagnostic accuracy for skin cancer when comparing physician specialty and experience, and examination methods. These summary metrics of clinician diagnostic accuracy could be useful benchmarks for clinical trials, practitioner trainin
重要性:皮肤癌是美国最常见的癌症;准确检测可最大限度地降低发病率和死亡率:根据病变类型、医生专业和经验以及体格检查方法,评估皮肤癌诊断的准确性:数据来源:PubMed、Embase 和 Web of Science:数据提取与综合:在研究开始前确定检索词、研究目标和方案方法。数据提取由一名审稿人完成,并由第二名审稿人进行核实。数据分析采用混合效应模型。数据分析时间为2022年5月至2023年12月:根据医生类型(初级保健医生或皮肤科医生;经验丰富或经验不足)和检查方法(当面临床检查和/或临床图像与皮肤镜检查和/或皮肤镜图像),对诊断准确性的敏感性和特异性进行Meta分析:共有 100 项研究被纳入分析。经验丰富的皮肤科医生使用临床检查和临床图像诊断角化细胞癌的灵敏度和特异度分别为79.0%和89.1%;使用皮肤镜和皮肤镜图像诊断角化细胞癌的灵敏度和特异度分别为83.7%和87.4%,初级保健医生的灵敏度和特异度分别为81.4%和80.1%。经验丰富的皮肤科医生使用当面皮肤镜检查和皮肤镜图像准确诊断角化细胞癌的几率是当面临床检查和图像的 2.5 倍。在使用临床检查和图像检查黑色素瘤时,经验丰富的皮肤科医生的敏感性和特异性分别为 76.9% 和 89.1%,经验不足的皮肤科医生为 78.3% 和 66.2%,初级保健医生为 37.5% 和 84.6%;而在使用皮肤镜和皮肤镜图像时,敏感性和特异性分别为 85.7% 和 81.3%,78.0% 和 69.5%,49.5% 和 91.3%。与临床检查相比,经验丰富的皮肤科医生使用皮肤镜准确诊断黑色素瘤的几率要高出 5.7 倍。与初级保健医生相比,经验丰富的皮肤科医生使用皮肤镜图像准确诊断黑色素瘤的几率要高出13.3倍:本系统综述和荟萃分析的结果表明,在比较医生的专业和经验以及检查方法时,皮肤癌的诊断准确率存在显著差异。这些临床医生诊断准确性的简要指标可作为临床试验、从业人员培训和新兴技术性能的有用基准。
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引用次数: 0
Application of Risk-Based Cancer Screening in Patients With Dermatomyositis. 基于风险的癌症筛查在皮肌炎患者中的应用
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-01 DOI: 10.1001/jamadermatol.2024.3355
Caroline J Stone, Daniella Forman Faden, Lillian Xie, Lais Lopes Almeida Gomes, Emily Z Hejazi, Victoria P Werth, Katharina S Shaw
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引用次数: 0
New-Onset Vulvar Edema in a Pediatric Patient. 一名儿科患者新发外阴水肿。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-01 DOI: 10.1001/jamadermatol.2024.2561
Eugeni Prat Colilles, Adrià Plana Pla, Isabel Bielsa Marsol
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引用次数: 0
Global Antimicrobial Susceptibility Patterns of Staphylococcus aureus in Atopic Dermatitis: A Systematic Review and Meta-Analysis. 特应性皮炎中金黄色葡萄球菌的全球抗菌药敏感性模式:系统回顾与元分析》。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-01 DOI: 10.1001/jamadermatol.2024.3360
Itzel Guadalupe Elizalde-Jiménez, Fernando Gerardo Ruiz-Hernández, Silvia Angélica Carmona-Cruz, Elena Pastrana-Arellano, Alejandra Aquino-Andrade, Carolina Romo-González, Eduardo Arias-de la Garza, Neri Alejandro Álvarez-Villalobos, Maria Teresa García-Romero

Importance: Individuals with atopic dermatitis are frequently colonized and infected with Staphylococcus aureus. Empirical antibiotic therapy for individuals with atopic dermatitis is common, but data about the antimicrobial susceptibility profiles of S aureus strains isolated from these individuals are scarce for those living in particular geographic areas.

Objective: To determine the antimicrobial susceptibility of S aureus from individuals with atopic dermatitis and analyze differences according to the income level of the country of origin and the data collection period.

Data sources: A meta-analysis of the literature was performed from the inception of the included databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane) to June 20, 2023, using predetermined Medical Subject Headings.

Study selection: Studies were included if they reported antibiotic susceptibility profiles of 1 or more S aureus cutaneous isolates from individuals with atopic dermatitis. Articles written in English, Spanish, French, or German were included.

Data extraction and synthesis: Working in pairs, 6 of the authors conducted the data extraction. The guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed.

Main outcomes and measures: The outcome of interest was antimicrobial susceptibility.

Results: A total of 61 studies reported 4091 S aureus isolates from individuals with atopic dermatitis. For 4 of the 11 commonly used antibiotics (36.4%), antimicrobial susceptibility was 85% or less, including for methicillin (binomial proportion, 0.85 [95% CI, 0.76-0.91]), erythromycin (binomial proportion, 0.73 [95% CI, 0.61-0.83]), fusidic acid (binomial proportion, 0.80 [95% CI, 0.62-0.91]), and clindamycin (binomial proportion, 0.79 [95% CI, 0.65-0.89]). Most studies (46; 75.4%) were conducted in high-income countries. Antimicrobial susceptibility to erythromycin, methicillin, and trimethoprim and sulfamethoxazole was significantly lower in lower middle-income countries and upper middle-income countries. Regarding the temporal trends, 33 studies (54.1%) reported data collected from 1998 to 2010. Antimicrobial susceptibility patterns have not changed over time.

Conclusions and relevance: In this systematic review and meta-analysis, antimicrobial susceptibility of S aureus to β-lactams, erythromycin, clindamycin, and fusidic acid may be suboptimal for empirical use in individuals with atopic dermatitis. Significant differences in antimicrobial susceptibility patterns were found in high-income countries and in lower middle-income countries and upper middle-income countries for some antibiotics.

重要性:特应性皮炎患者经常定植和感染金黄色葡萄球菌。对特应性皮炎患者进行经验性抗生素治疗很常见,但从这些患者身上分离出的金黄色葡萄球菌菌株对特定地理区域的抗菌药敏感性数据却很少:目的:确定特应性皮炎患者金黄色葡萄球菌的抗菌药敏感性,并分析原籍国收入水平和数据收集时间的差异:采用预先确定的医学主题词,对从纳入数据库(MEDLINE、Embase、Web of Science、Scopus 和 Cochrane)开始到 2023 年 6 月 20 日期间的文献进行了荟萃分析:如果研究报告了来自特应性皮炎患者的一种或多种金黄色葡萄球菌皮肤分离物的抗生素敏感性概况,则纳入该研究。数据提取与综合:6 位作者两人一组进行数据提取。数据提取和综合:6 位作者两人一组进行数据提取,并遵循《系统综述和荟萃分析首选报告项目》(PRISMA)指南:主要结果和测量指标:相关结果为抗菌药物敏感性:共有 61 项研究报告了来自特应性皮炎患者的 4091 例金葡菌分离物。在 11 种常用抗生素中,有 4 种(36.4%)的抗菌药敏感性为 85% 或更低,其中包括甲氧西林(二项式比例,0.85 [95% CI,0.76-0.91])、红霉素(二项式比例,0.85 [95% CI,0.76-0.91])、氨苄西林(二项式比例,0.85 [95% CI,0.76-0.91])。91])、红霉素(二项比例,0.73 [95% CI,0.61-0.83])、夫西地酸(二项比例,0.80 [95% CI,0.62-0.91])和克林霉素(二项比例,0.79 [95% CI,0.65-0.89])。大多数研究(46;75.4%)在高收入国家进行。中低收入国家和中高收入国家对红霉素、甲氧西林、三甲氧苄氨嘧啶和磺胺甲噁唑的抗菌药物敏感性明显较低。关于时间趋势,33 项研究(54.1%)报告了 1998 年至 2010 年收集的数据。随着时间的推移,抗菌药敏感性模式没有发生变化:在这项系统回顾和荟萃分析中,金黄色葡萄球菌对β-内酰胺类、红霉素、克林霉素和夫西地酸的抗菌药敏感性可能低于特应性皮炎患者经验性用药的最佳敏感性。在高收入国家、中低收入国家和中高收入国家,某些抗生素的抗菌药敏感性模式存在显著差异。
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引用次数: 0
Clinical Application of New Risk-Based Cancer Screening in Patients With Dermatomyositis. 基于风险的新型癌症筛查在皮肌炎患者中的临床应用。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-01 DOI: 10.1001/jamadermatol.2024.3349
Andrea D Maderal, Alisa Femia
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引用次数: 0
Dermatology Encounters After Solid Organ Transplant. 实体器官移植后的皮肤病治疗。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-01 DOI: 10.1001/jamadermatol.2024.3173
Surya A Veerabagu, Kai-Ping Liao, Anokhi Jambusaria-Pahlajani, Lee Wheless, Mackenzie R Wehner
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引用次数: 0
Treatment of Annular Elastolytic Giant Cell Granuloma With Tofacitinib. 托法替尼治疗环状溶解性巨细胞肉芽肿
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-11-01 DOI: 10.1001/jamadermatol.2024.3435
Tian-Yi Zhang, Tao Qu
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引用次数: 0
期刊
JAMA dermatology
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