Missouri medicine最新文献

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation treatment for major depressive disorder. Randomized controlled trials show response rates twice times higher for TMS (23.9%) than placebo (12.3%) in adults with depression. Real world studies showed increased response rates up to 58% in clinically heterogenous adult patient populations. TMS is safe and well tolerated with a benign side effect profile and high adherence. Standard TMS protocols include left dorso-lateral prefrontal cortex stimulation using a fixed stimulation protocol or burst-patterned protocols such as intermittent theta burst delivered over six weeks. Novel accelerated protocols using high daily dosing and functional MRI targeting provide increased precision and improved treatment outcomes. TMS shows effectiveness in patients with comorbid anxiety, older adults and adolescents for which received FDA approval in 2024. Future studies incorporating neuroimaging techniques may help to refine protocols leading to improved outcomes across different patient populations.

Tattoos have been culturally significant throughout history and continue to serve as an avenue for self-expression, cosmetic enhancement, and medical applications in the modern era. Despite their popularity, tattoos are not without clinical implications, including inflammatory reactions, infections, scarring, and even associations with cutaneous malignancies. This review explores the natural course of tattoo-related skin reactions, focusing on the acute and chronic inflammatory responses to pigment deposition, including allergic contact dermatitis, lichenoid reactions, and granulomatous inflammation. Tattoo-related infections, ranging from bacterial to viral and fungal, are also discussed, highlighting the importance of sterile tattooing practices. Further, the potential for scarring, including hypertrophic scars, keloids, and dermatofibromas, is evaluated, particularly in individuals with a predisposition for abnormal wound healing. Although no direct causative link between tattoos and skin cancers has been established, tattoos can obscure early detection of malignancies, potentially delaying diagnosis and increasing morbidity. This article also examines emerging trends in cosmetic tattooing, such as scleral tattoos, microblading, and scar camouflage, noting both the benefits and potential complications. Management strategies for tattoo complications, including medical and procedural interventions, are outlined. Treatments include corticosteroids for inflammatory reactions, laser therapy for pigment alteration, and surgical options for severe scarring. The growing field of cosmetic tattooing requires continued research into the long-term outcomes and management of tattoo-related complications to ensure both aesthetic and medical safety for individuals seeking these modifications.

Adverse childhood experiences (ACEs) increase depression risk and may affect antidepressant (ADM) treatment outcomes; however, cumulative research on each ACE in conjunction with ADM outcomes is lacking. This review aims to examine the relationship between ACEs and ADM. We examined PsychInfo and PubMed/MEDLINE databases from 2010-2025 and identified 26 publications that met review criteria (i.e., peer-reviewed and concurrently examined ACEs and ADM). ACEs were associated with an increased propensity to use ADMs, an interaction between DNA methylation and ADM efficacy, an increased risk of suicide while on ADMs, and ADM responsiveness. The majority of the studies show serotonin modulators and stimulators, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors are associated with fewer depressive symptoms in ACE survivors. Multiple ACEs and child abuse impaired ADM effectiveness. Yet, genetic links and age when the ACE occurred may explain this vulnerability. These findings should be interpreted with caution, as cumulatively, the research often had smaller sample sizes in the ACE history groups, research often did not test antidepressants against each other, and reported depression symptom changes in the studies may be organic symptom reduction unrelated to treatment. Before medical providers initiate depression treatment, they should ask their patients about ACE history. If patients confide they have these experiences, medical providers will want to consider treatment drug class and establish a plan to monitor the patient carefully for unremitting symptoms, symptoms severity, and suicide risk.

Piercings have evolved from ancient cultural traditions to a mainstream form of body modification, interweaving personal expression and modern medicine. This review traces the historical origins of piercings, highlighting cultural significances and transformation into contemporary trends. As piercings have become increasingly commonplace, the incidence of medical complications has risen, necessitating medical and surgical intervention. Moreover, the growing popularity of body modifications, including gauges and dermal implants, presents unique surgical challenges in reconstructive procedures following piercing removal. By exploring the intersection of historic cultural practices and medical science, this review aims to provide a broad understanding of the evolution of piercings and considerations for physicians managing piercing-related concerns.