Efficacy and Safety of Fractional Microneedle Radiofrequency for Atrophic Acne Scars
FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.
Summary
A Real-World Clinical Study of 126 Patients
[Posted 19/Mar/2024]
AUDIENCE: General Surgery, Family Medicine
KEY FINDINGS: FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.
BACKGROUND: Purpose of this study is to analyze the clinical efficacy and safety of fractional microneedle radiofrequency (FMR) for facial atrophic acne scars in a real-world setting.
DETAILS: The clinical data of patients with atrophic acne scars who had received FMR therapy from February 2018 to August 2022 were retrospectively analyzed. The improvement of atrophic acne scars was assessed using the ECCA Grading Scale (échelle d'évaluation clinique des cicatrices d'acné), Global Aesthetic Improvement Scale (GAIS), and modified Manchester Scar Scale (mMSS). Adverse reactions during FMR treatment were also recorded. Univariate and multivariate logistic regression analyses were performed to evaluate the efficacy and safety of FMR for atrophic acne scars. A total of 126 patients with facial atrophic acne scars were included. A total of 590 FMR treatment sessions were accomplished, with each of 82 patients receiving 4 or more treatment sessions, and 1 receiving a maximum of 14 sessions. All patients showed improvement in symptoms after FMR treatment, with moderate to significant improvement (ECCA score reduction of 26%–100%) in 92 (73.0%) patients. As the number of treatment sessions increased, the ECCA score gradually decreased from an average of 85.6 before to 35.0 after FMR. The average scores for distortion, color, and visual analogue scale (VAS) of mMSS all showed certain reductions. The change in GAIS score indicated improvement after treatment, with minimal improvement in 16 patients (12.7%), good improvement in 57 patients (45.2%), significant improvement in 45 patients (35.7%), and optimal improvement in 8 patients (6.4%). The univariate and multivariate logistic regression analyses revealed that the long pulse width and the number of FMR treatment sessions were positively associated with clinical efficacy. Compared to the short pulse-width group (200 ms), the longer pulse-width group (300 ms) (odds ratio [OR] = 8.3, p = 0.003) and the even longer pulse-width group (400–500 ms) (OR = 52.6, p 0.001) demonstrated stronger efficacies. Patients who received more than three treatment sessions had better outcomes compared to those who received three or fewer treatment sessions (OR = 4.0, p = 0.036). All patients experienced posttreatment transient erythema, but no crusting, infection, or blister. Six cases developed grid-like erythema around 1 month posttreatment and one case experienced hyperpigmentation, both of which resolved within 1–3 months after appropriate management.
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Source: Ziwei, D., Yuan, G., Yuehong, G., et al. (2024). Efficacy and Safety of Fractional Microneedle Radiofrequency for Atrophic Acne Scars: A Real-World Clinical Study of 126 Patients. Lasers Surg. Med.. 2024; 56(2): 150-164. Published: February, 2024. DOI: 10.1002/lsm.23759.
Microbial Dominance in Diabetic Foot Osteomyelitis Determined With Nanopore Sequencing Techniques Predicts Positive Response to Surgical Intervention
In patients with surgically treated OM, nanopore sequencing can generate interpretable metagenomic data from bone specimens that are culture concordant and associated with clinical response. These findings support the feasibility and plausibility of using real-time metagenomic sequencing to improve the clinical management of OM.
KEY FINDINGS: In patients with surgically treated OM, nanopore sequencing can generate interpretable metagenomic data from bone specimens that are culture concordant and associated with clinical response. These findings support the feasibility and plausibility of using real-time metagenomic sequencing to improve the clinical management of OM.
BACKGROUND: Tools to predict successful response to surgery for the treatment of diabetic foot osteomyelitis (OM) are currently lacking. Recent studies in nonbone infections have revealed that nanopore sequencing can provide real-time metagenomic identification of pathogens. In a cohort of patients with diabetic foot OM, we tested the feasibility of generating interpretable metagenomic data from surgically acquired osseous tissue, comparing bacterial community features (pathogen dominance) with clinical outcomes (resolution of infection). Researchers hypothesized that nanopore-generated microbial data can be feasibly generated from surgically acquired bone, aligns with conventional culture results, and is predictive of clinical response.
DETAILS: Researchers performed a pilot feasibility study of 10 consecutive patients hospitalized with diabetic foot OM who underwent surgery for OM. We performed metagenomic sequencing of surgical bone samples using the MinION (Oxford Nanopore). The primary metagenomic index was community dominance (relative abundance of most abundant species). The primary clinical end point was the clinical response to surgery, adjudicated at 1 year. Authors successfully generated interpretable metagenomic data from all 10 specimens, including 2 with negative culture growth. Among culture-positive specimens, the culture-identified pathogen was either the first or second most abundant organism in all cases. Patients with favorable clinical response exhibited greater pathogen dominance than those with unfavorable response (P = .002).
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Copyright © The Authors. Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
Source: Schmidt, B. M., Ranjan, P., Erb-Downward, J., et al. Microbial Dominance in Diabetic Foot Osteomyelitis Determined With Nanopore Sequencing Techniques Predicts Positive Response to Surgical Intervention. The Journal of Infectious Disease. 2026; 233(3): 458-464. Published: March 15, 2026. DOI: 10.1093/infdis/jiaf617
Risk of Dyslipidemia Associated With Oral Janus Kinase Inhibitors
The meta-analysis found that all four JAKi drugs examined - baricitinib, upadacitinib, tofacitinib, and decernotinib - were associated with measurable increases in both HDL and LDL cholesterol compared to placebo. Notably, LDL elevations ranged from approximately 9 to 16 mg/dL depending on the drug, raising potential cardiovascular concerns. The authors conclude that dyslipidemia is a meaningful risk associated with JAKi therapy, and recommend that clinicians conduct routine lipid monitoring and regular cardiovascular risk assessments for patients on these medications to ensure long-term safety.
Summary
A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials
[Posted 16/Mar/2026]
AUDIENCE: Dermatology, Oncology
KEY FINDINGS: This systematic review and meta-analysis highlight the risk of dyslipidemia during treatment with JAKi, which could pose cardiovascular risks. Thus, regular assessments of cardiovascular risk factors and routine lipid monitoring in patients undergoing JAKi therapy may be essential for managing dyslipidemia and evaluating long-term cardiovascular safety.
BACKGROUND: Janus kinase inhibitors (JAKi) have sparked a new era in the treatment of immune-mediated diseases. While some studies have reported an increased incidence of dyslipidemia in JAKi-treated patients, the full extent of this adverse event is not established. The study aimed to assess the association between treatment with oral JAKi and dyslipidemia in phases 2 and 3 placebo-controlled randomized clinical trials (RCTs).
DETAILS: Janus kinase inhibitors (JAKi) have sparked a new era in the treatment of immune-mediated diseases. While some studies have reported an increased incidence of dyslipidemia in JAKi-treated patients, the full extent of this adverse event is not established. The study aimed to assess the association between treatment with oral JAKi and dyslipidemia in phases 2 and 3 placebo-controlled randomized clinical trials (RCTs). A systematic review and meta-analysis were conducted, encompassing phase 2 and 3 RCTs. The Embase, PubMed, and Web of Science databases were searched up to March 9, 2025. Only RCTs reporting lipid levels before and after treatment with JAKi were included. Data were extracted for changes in high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG) with values reported in mg/dL. A total of 13 studies were included in the analysis, comprising nine studies on rheumatoid arthritis, two on atopic dermatitis, one on Crohn's disease, and one on psoriasis. The studies encompassed a total of 3978 patients treated with JAKi and 1680 controls. Across all indications, the mean difference between JAKi and placebo for individual drug, was increased by 6.07 mg/dL (95% confidence interval [CI], 5.01-7.14) for HDL and 9.05 mg/dL (95% CI, 7.78-10.32) for LDL for baricitinib; HDL 5.4 mg/dL (95% CI, 3.2-7.7) and LDL 12.4 mg/dL (95% CI, 8.9-15.9) for upadacitinib; HDL 7.0 mg/dL (95% CI, 5.7-8.3) and LDL 15.7 mg/dL (95% CI, 12.9-18.6) for tofacitinib; and lastly HDL 3.0 mg/dL (95% CI, 0.2-5.8) and LDL 14.9 mg/dL (95% CI, 3.6-26.3) for decernotinib.
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Source: Isufi, D., Javanmardi, N., Jense, M. B., et al. Risk of Dyslipidemia Associated With Oral Janus Kinase Inhibitors: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. International Journal of Dermatology. 2026; 65: 737-745. Published: March, 2026. DOI: 10.1111/ijd.70122
Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications
Complication rates were low after vaginal hysterectomy and laparoscopic hysterectomy. The study results suggest that vaginal hysterectomy is not clearly a preferred route for hysterectomy over laparoscopic hysterectomy. The data support further investigation of the optimal surgical approach for hysterectomy with large, prospective clinical studies.
Summary
Complications and Length of Stay in a National Analysis of Contemporary Data
[Posted 3/Mar/2026]
AUDIENCE: Ob/Gyn, Oncology
KEY FINDINGS: Complication rates were low after vaginal hysterectomy and laparoscopic hysterectomy. The study results suggest that vaginal hysterectomy is not clearly a preferred route for hysterectomy over laparoscopic hysterectomy. The data support further investigation of the optimal surgical approach for hysterectomy with large, prospective clinical studies.
BACKGROUND: The current recommendation to select vaginal hysterectomy for benign indications whenever feasible is based on clinical trials with limited cohorts and older data. This study aimed to evaluate the association between the hysterectomy route (vaginal hysterectomy or laparoscopic/robotic hysterectomy) and short-term outcomes.
DETAILS: A cohort study was conducted using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2022. Women who underwent vaginal hysterectomy or laparoscopic hysterectomy for benign indications were included. Abdominal hysterectomies, laparoscopic/robotic supracervical hysterectomies, laparoscopic-assisted vaginal hysterectomies, and emergent surgical procedures were excluded. Propensity score matching and multivariate regression analyses were performed to assess outcomes. The primary outcome was the occurrence of complications within 30 days, which was stratified using the Clavien-Dindo classification. The secondary outcomes included operative time, overnight admission, and hospital length of stay. After propensity score matching for patients’ demographics and surgical characteristics, including uterine weight (<250 g or >250 g) and concomitant procedures performed, 83,436 women were included in the analysis, with 41,718 patients each in the vaginal hysterectomy and laparoscopic hysterectomy groups in a 1:1 ratio. Postoperative complications were low in the vaginal hysterectomy and laparoscopic hysterectomy groups (8.2% vs 6.4%, respectively; P<.001; adjusted odds ratio, 1.23 [95% confidence interval, 1.15-1.31]). Major and minor complication risks were minimally increased in the vaginal hysterectomy group. Specifically, vaginal hysterectomy was associated with higher risks of blood transfusion, urinary tract infection, organ/space infection, and reoperation, and laparoscopic hysterectomy was associated with higher risks of wound dehiscence and pulmonary embolism. Operative time was shorter in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (109.6 vs 137.0 minutes, respectively; P<.001). The proportions of overnight admission were 35.5% after vaginal hysterectomy and 27.2% after laparoscopic hysterectomy (adjusted odds ratio, 2.10 [95% confidence interval, 2.02-2.18]). Hospital lengths of stay for >=1 day were 77.9% in the vaginal hysterectomy group and 77.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.90 [95% confidence interval, 1.82-1.99]). In addition, hospital lengths of stay for >=2 days were 13.2% in the vaginal hysterectomy group and 10.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.55 [95% confidence interval, 1.47-1.63]).
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Source: Meyer, R., Hamilton, K. M., Ezike, O., et al. Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications: Complications and Length of Stay in a National Analysis of Contemporary Data. American Journal of Obstetrics & Gynecology. 2026; 234(3): 620-631. Published: March, 2026. DOI: 10.1016/j.ajog.2025.10.027.
Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy
Topical MB-mediated PDT successfully managed HPV-related FEH in an immunocompromised individual with history of valve disease. This outcome supports the need for further validation through clinical trials.
KEY FINDINGS: PDT mediated by MB is an effective and affordable approach for treating FEH associated with HPV in immunosuppressed patients, offering favorable outcomes and improved quality of life.
BACKGROUND: Human papillomavirus (HPV) infections are a major cause of oral lesions, and in individuals living with HIV, lesions such as focal epithelial hyperplasia (FEH) may persist or exhibit atypical features, potentially progressing to more severe conditions if untreated. Managing oral HPV lesions in immunocompromised patients is challenging, as conventional therapies may carry higher risks or show limited efficacy.
DETAILS: This study reports the case of a 49-year-old HIV-positive male with valve disease and arthritis, requiring crutches for mobility. He presented with multiple painless oral lesions, diagnosed as FEH associated with oral HPV, and had previously undergone unsuccessful treatments. Photodynamic therapy (PDT) using methylene blue (MB) and a red laser was proposed as a treatment. Topical MB-mediated PDT successfully cleared the FEH lesions, with no recurrence observed over 24 months.
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Source: de Araújo, J. C., Paiva, H. C., Faara, P. M. M., et al. Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy. A Case Report. Lasers in Surgery and Medicine. 2026; 58(2): 70-73. Published: February, 2026. DOI: 10.1002/lsm.70091
Oral Itraconazole Versus Oral Voriconazole for Treatment-Naive Patients With Chronic Pulmonary Aspergillosis in India (VICTOR-CPA Trial)
Voriconazole was not superior to itraconazole for treating chronic pulmonary aspergillosis and was associated with a significantly higher incidence of adverse events. Our findings support the continued use of itraconazole as the preferred therapy for chronic pulmonary aspergillosis, although voriconazole remains a reasonable alternative. The choice between the two agents should be guided by factors such as patient tolerance, drug availability, and cost considerations.
Summary
A Single-Centre, Open-Label, Randomised, Controlled, Superiority Trial
[Posted 28/Feb/2026]
AUDIENCE: Infectious Disease
KEY FINDINGS: Voriconazole was not superior to itraconazole for treating chronic pulmonary aspergillosis and was associated with a significantly higher incidence of adverse events. Our findings support the continued use of itraconazole as the preferred therapy for chronic pulmonary aspergillosis, although voriconazole remains a reasonable alternative. The choice between the two agents should be guided by factors such as patient tolerance, drug availability, and cost considerations.
BACKGROUND: Both itraconazole and voriconazole are used to treat chronic pulmonary aspergillosis. However, treatment success with itraconazole is only around 65-70%. Voriconazole, with its lower minimum inhibitory concentrations and better oral bioavailability, might offer improved outcomes, but no head-to-head comparison has been conducted to date. We aimed to evaluate whether oral voriconazole is superior to itraconazole in treating chronic pulmonary aspergillosis.
DETAILS: This single-centre, prospective, open-label, superiority trial was conducted at the chest clinic of a tertiary care hospital in Chandigarh, India. We enrolled treatment-naive adults aged 18 years or older with chronic cavitary pulmonary aspergillosis or chronic fibrosing pulmonary aspergillosis. We excluded those who denied consent, received any antifungal azoles for more than 3 weeks in the previous 6 months, or had other forms of aspergillosis. Participants were randomly assigned 1:1 to receive 200 mg twice daily of oral itraconazole or oral voriconazole for 6 months, using a computer-generated randomisation sequence with variable block sizes (4-8). Participants, staff administering the interventions, clinical outcome assessors, and data analysts were not masked to treatment assignment; a radiologist masked to clinical details and treatment allocation evaluated chest images. The primary outcome was the proportion of participants achieving a favourable response (clinical and radiological stability or improvement) at 6 months in the modified intention-to-treat population, which included all participants who received at least one dose of the allocated treatment. The safety analyses (a secondary outcome) were also performed in the modified intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04824417) and is complete. Between April 15, 2021, and May 31, 2024, 150 individuals were screened, and 116 were randomly assigned to receive itraconazole (n=58) or voriconazole (n=58). Of the 116 participants, 74 (64%) were men, 42 (36%) were women, and the mean age was 45.9 years (SD 14.4). All participants received at least one dose of the study drug and were included in the primary analysis. The proportion of participants achieving a favourable response at 6 months was similar in both groups (69% [40 of 58] receiving voriconazole vs 67% [39 of 58] receiving itraconazole; absolute risk reduction -0.02 [95% CI -0.2 to 0.15], p=0.84). Voriconazole was associated with significantly more treatment-related adverse events than itraconazole (55% [32 of 58] of participants receiving voriconazole vs 34% [20 of 58] receiving itraconazole, p=0.025). There were four deaths, all in the voriconazole group; none were directly attributable to the treatment.
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Source: Sehgal, I. S., Agarwal, R., Dhooria, S., et al. Oral Itraconazole Versus Oral Voriconazole for Treatment-Naive Patients With Chronic Pulmonary Aspergillosis in India (VICTOR-CPA Trial): A Single-Centre, Open-Label, Randomised, Controlled, Superiority Trial. The Lancet Infectious Diseases. 2026; 26(3): 239-249 Published: March, 2026. DOI: 10.1016/S1473-3099(25)00537-7.
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