Wyles, Saranya P.

Abstract The objective was to evaluate the impact of an interdisciplinary graduate level course on students’ knowledge and interests in immunotherapy and CAR-T cell therapy. It was a one week course conducted in November 2018. Students were surveyed before and after the course. The survey included questions regarding background, self-perceived knowledge/confidence in skills, and interests/predicted behaviors. Students were assigned to work in interdisciplinary teams to develop a research proposal. A total of 25 students taking the course for graduate level credit were surveyed. Of these, all 25 (100%) completed the surveys. Students came from variable backgrounds and were at different stages of graduate training. After completion of the course, there was a statistically significant increase in self-perceived knowledge of immunotherapy (mean±standard deviation score of 3.6±0.9 post-course vs 2.6±1.0 pre-course, on a 5 point Likert scale, P<0.001), knowledge of the benchtop research to clinic translational process (3.7±0.8 post-course vs 3.0±0.9 pre-course, P<0.001), confidence in critical reading skills (4.3±0.6 post-course vs 4.0±0.5 pre-course, P=0.008), confidence in immunotherapy focused grant writing skills (3.6±0.9 post-course vs 2.8±1.1 pre-course, P<0.001), interest in working in interdisciplinary teams (4.8±0.4 post-course vs 4.6±0.6 pre-course, P=0.02), and interest in attending immunotherapy educational events (3.5±1.3 post-course vs 3.2±1.3 pre-course, P≤0.05). In conclusion, this course helps trainees to build knowledge and interest in the fields of immunotherapy and CAR-T cell therapy and can potentially serve as a platform for future educational courses in interdisciplinary, translational research.

Summary: Beyond the palliative reach of today’s medicines, medical therapies of tomorrow aim to treat the root cause of age-related diseases by targeting fundamental aging mechanisms. Pillars of aging include, among others, genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, dysregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. The unitary theory of fundamental aging processes posits that by targeting one fundamental aging process, it may be feasible to impact several or all others given its interdependence. Indeed, pathologic accumulation of senescent cells is implicated in chronic diseases and age-associated morbidities, suggesting that senescent cells are a good target for whole-body aging intervention. Preclinical studies using senolytics, agents that selectively eliminate senescent cells, and senomorphics, agents that inhibit production or release of senescence-associated secretory phenotype factors, show promise in several aging and disease preclinical models. Early clinical trials using a senolytic combination (dasatinib and quercetin), and other senolytics including flavonoid, fisetin, and BCL-xL inhibitors, illustrate the potential of senolytics to alleviate age-related dysfunction and diseases including wound healing. Translation into clinical applications requires parallel clinical trials across institutions to validate senotherapeutics as a vanguard for delaying, preventing, or treating age-related disorders and aesthetic aging.

Abstract Background Exosomes are regenerative mediators for skin rejuvenation. Human platelet extract (HPE) is an allogeneic exosome product derived from US-sourced, leukocyte-reduced apheresed platelets with consistent purity and potency. Objectives The authors sought to better characterize the safety and tolerability of novel HPE (plated) Intensive Repair Serum (Rion Aesthetics, Rochester, MN) and its maximal effects on skin rejuvenation at 6 weeks. Methods This prospective, single-arm, non-randomized, longitudinal study investigated the safety and efficacy of HPE. Structured sub-analysis evaluated multifactorial improvement in skin health following standardized skin care regimen to determine the maximal effect. Evaluation at baseline and 6 weeks included participant questionnaires and photo documentation with VISIA-CR Generation 5 3D PRIMOS (Canfield Scientific Inc, Fairfield, NJ). Results VISIA-CR imaging yielded quantifiable and statistically significant improvements in overall skin health (skin health score). A greater score correlated to greater overall skin health, and there was a statistically significant mean delta improvement of 224.2 ± 112.8 (mean ± standard deviation, P ≤ 0.0001) in skin health score at 6 weeks compared with baseline. This correlated to reduction in redness, wrinkles, and melanin production across all cosmetic units (P = 0.005, P = 0.0023, P ≤ 0.0001, respectively) and significant improvements in luminosity and color evenness (P ≤ 0.001). Conclusions A topically applied platelet-derived exosome product, HPE, induced normalization to skin health at 4 to 6 weeks with improved various clinical measures of facial photodamage and cutaneous aging. It is safe, well-tolerated, and well-liked by participants. Level of Evidence: 4

While fundamental principles of anatomy are well‐established in early medical training, continued retention of anatomical knowledge is dependent on value, importability and relevance to surgical practice. As novel reconstructive strategies emerge, surgeons must account for individual patient factors and comorbidities in predicting patient outcome. Mastery of planning requires precise knowledge of local anatomy and reconstructive techniques, warranting reconnection with prior anatomic knowledge. Finding dedicated time to learn anatomy through self‐guided approach, is often challenging in a busy practice and CPD opportunities become a highly valued resource. In recent years, two mainstream professional dermatology societies have provided a platform for delivery of anatomy based clinical sessions. This study aims to assess value of point of care delivery of relevant anatomy and its role in improving perception of surgical confidence amongst procedural dermatologists in a CPD course. Assessment of core knowledge and knowledge gaps was conducted through the American College of Mohs Surgery (ACMS). Objectives were designed by a team of anatomists and clinicians based on a series of challenging cases. Anatomy sessions were offered at a large general session (>300 participants) and a small group hands‐on flap based session (n=20) Key anatomic teaching points relating to danger zones, safe zones and functional impairment were highlighted. Videos of real‐time dissection using a layered approach of targeted anatomy were created and supplemented with 3D‐printed models. For challenging anatomy encountered during Mohs reconstruction, patient defects were re‐created on the cadaver highlighting pertinent anatomy. Qualitative and quantitative analyses were conducting using course review for general session and confidence rating using Likert scale of anatomy based objectives for small group session. While 60–90 minute general session was sufficient for anatomist‐clinician team to facilitate discussion, participants indicated strong desire for increased session time. Videos and high quality photography were seen as outstanding tools for demonstrating anatomy within surgical field. Participants strongly valued anatomist/clinician partnership and relevance of material to everyday practice. Session review data (n=78) indicated session objectives “improved their ability to provide excellent patient care by helping close practice gaps”( 89.74%), helped “identify practice gaps in knowledge, performance and outcomes” (83.33%) and material presented was relevant to their Mohs and dermatologic practice (100%). Within small group session (n=11), only 18% had access to anatomy facility and material, with 100% agreeing/strongly agreeing that anatomy education was critical to their current practice. Analysis of perceived confidence in anatomic knowledge post course showed significant improvement in confidence in identifying, isolating and visualizing relevant anatomical (p<0.05). Positive impact of collaborative teaching of anatomy outside a mainstream academic setting using targeted point of care delivery through the use of technology (video), products of technology (photography and 3D‐printed material) and patient based clinical discussion to improve physician confidence was demonstrated. In era of authentic learning, anatomists share a responsibility for bringing point‐of‐care content for improved patient care. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Abstract Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta‐analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser‐based devices in combination with intralesional steroids, or 5‐fluorouracil (5‐FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell‐based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient‐focused, evidence‐based clinical decision making.