The American College of Surgeons (ACS) Division of Education is offering fellowships in surgical ethics with the MacLean Center for Clinical Medical Ethics, University of Chicago, IL. The MacLean Center will prepare two surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics beginning with a five-week, full-time course in Chicago in July and August 2018. From September 2018 to June 2019, fellowship recipients will meet weekly for a structured ethics curriculum. In addition, fellows will participate in an ethics consultation service and complete a research project. For additional information about this fellowship, contact Patrice Gabler Blair, MPH, Associate Director, ACS Division of Education, at [email protected].

Application materials are due March 1, 2018.

The American College of Surgeons (ACS) Division of Education is offering fellowships in surgical ethics with the MacLean Center for Clinical Medical Ethics, University of Chicago, IL. The MacLean Center will prepare two surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics beginning with a five-week, full-time course in Chicago in July and August 2018. From September 2018 to June 2019, fellowship recipients will meet weekly for a structured ethics curriculum. In addition, fellows will participate in an ethics consultation service and complete a research project. For additional information about this fellowship, contact Patrice Gabler Blair, MPH, Associate Director, ACS Division of Education, at [email protected].

Application materials are due March 1, 2018.

The American College of Surgeons (ACS) Division of Education is offering fellowships in surgical ethics with the MacLean Center for Clinical Medical Ethics, University of Chicago, IL. The MacLean Center will prepare two surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics beginning with a five-week, full-time course in Chicago in July and August 2018. From September 2018 to June 2019, fellowship recipients will meet weekly for a structured ethics curriculum. In addition, fellows will participate in an ethics consultation service and complete a research project. For additional information about this fellowship, contact Patrice Gabler Blair, MPH, Associate Director, ACS Division of Education, at [email protected].

Application materials are due March 1, 2018.

The Commission on Cancer (CoC) of the American College of Surgeons (ACS) has granted its mid-year 2017 Outstanding Achievement Award to a select group of 16 accredited cancer programs throughout the U.S. Award criteria are based on qualitative and quantitative surveys conducted in the first half of 2017. A list of these award-winning cancer programs is available at www.facs.org/quality-programs/cancer/coc/info/outstanding/2017-part-1.

The purpose of the award is to raise the bar on quality cancer care, with the ultimate goal of increasing awareness about quality care choices among cancer patients and their loved ones. In addition, the award is intended to fulfill the following goals:

• Recognize those cancer programs that achieve excellence in providing quality care to cancer patients

• Motivate other cancer programs to work toward improving their level of care

• Facilitate dialogue between award recipients and health care professionals at other cancer facilities for the purpose of sharing best practices

• Encourage honorees to serve as quality care resources to other cancer programs

“More and more, we’re finding that patients and their families want to know how the health care institutions in their communities compare with one another,” said Lawrence N. Shulman, MD, FACP, Chair of the CoC. “They want access to information in terms of who’s providing the best quality of care, and they want to know about overall patient outcomes. Through this recognition program, I’d like to think we’re playing a small but vital role in helping them make informed decisions on their cancer care.”

The 16 award-winning cancer care programs represent approximately 6 percent of programs surveyed by the CoC January 1–June 30, 2017. “These cancer programs currently represent the best of the best when it comes to cancer care,” added Dr. Shulman.

The Commission on Cancer (CoC) of the American College of Surgeons (ACS) has granted its mid-year 2017 Outstanding Achievement Award to a select group of 16 accredited cancer programs throughout the U.S. Award criteria are based on qualitative and quantitative surveys conducted in the first half of 2017. A list of these award-winning cancer programs is available at www.facs.org/quality-programs/cancer/coc/info/outstanding/2017-part-1.

The purpose of the award is to raise the bar on quality cancer care, with the ultimate goal of increasing awareness about quality care choices among cancer patients and their loved ones. In addition, the award is intended to fulfill the following goals:

• Recognize those cancer programs that achieve excellence in providing quality care to cancer patients

• Motivate other cancer programs to work toward improving their level of care

• Facilitate dialogue between award recipients and health care professionals at other cancer facilities for the purpose of sharing best practices

• Encourage honorees to serve as quality care resources to other cancer programs

“More and more, we’re finding that patients and their families want to know how the health care institutions in their communities compare with one another,” said Lawrence N. Shulman, MD, FACP, Chair of the CoC. “They want access to information in terms of who’s providing the best quality of care, and they want to know about overall patient outcomes. Through this recognition program, I’d like to think we’re playing a small but vital role in helping them make informed decisions on their cancer care.”

The 16 award-winning cancer care programs represent approximately 6 percent of programs surveyed by the CoC January 1–June 30, 2017. “These cancer programs currently represent the best of the best when it comes to cancer care,” added Dr. Shulman.

The Commission on Cancer (CoC) of the American College of Surgeons (ACS) has granted its mid-year 2017 Outstanding Achievement Award to a select group of 16 accredited cancer programs throughout the U.S. Award criteria are based on qualitative and quantitative surveys conducted in the first half of 2017. A list of these award-winning cancer programs is available at www.facs.org/quality-programs/cancer/coc/info/outstanding/2017-part-1.

The purpose of the award is to raise the bar on quality cancer care, with the ultimate goal of increasing awareness about quality care choices among cancer patients and their loved ones. In addition, the award is intended to fulfill the following goals:

• Recognize those cancer programs that achieve excellence in providing quality care to cancer patients

• Motivate other cancer programs to work toward improving their level of care

• Facilitate dialogue between award recipients and health care professionals at other cancer facilities for the purpose of sharing best practices

• Encourage honorees to serve as quality care resources to other cancer programs

“More and more, we’re finding that patients and their families want to know how the health care institutions in their communities compare with one another,” said Lawrence N. Shulman, MD, FACP, Chair of the CoC. “They want access to information in terms of who’s providing the best quality of care, and they want to know about overall patient outcomes. Through this recognition program, I’d like to think we’re playing a small but vital role in helping them make informed decisions on their cancer care.”

The 16 award-winning cancer care programs represent approximately 6 percent of programs surveyed by the CoC January 1–June 30, 2017. “These cancer programs currently represent the best of the best when it comes to cancer care,” added Dr. Shulman.

The American College of Surgeons (ACS) is accepting applications for the 2018 Joan L. and Julius H. Jacobson II Promising Investigator Award (JPIA) through February 23.

The JPIA was established to recognize outstanding surgeons who are engaging in research, advancing the art and science of surgery, and demonstrating early promise of significant contribution to the practice of surgery and the safety of surgical patients. The award is supported through a generous endowed fund established by the donors and administered by the ACS Surgical Research Committee.
 

Award criteria

The criteria for selection of the JPIA winner are as follows:

• Candidate must be a Fellow or an Associate Fellow of the ACS.

• Candidate must be board certified in a surgical specialty and must have completed surgical training, including fellowship, in the last six years, excluding military, medical, or family leave.

• Candidate must hold a faculty appointment at a research-based academic medical center or hold a military service position.

• Candidate must have received peer-reviewed funding, such as a K-series award from the National Institutes of Health (NIH), Veterans Administration, National Science Foundation, or U.S. Department of Defense merit review award to support their research effort. Surgeon-scientists who are well established (for example, recipients of NIH R01 and Veterans Affairs Merit grants or equivalent grants from other agencies) are ineligible.

• Only one application per surgical department will be accepted.

• Nomination documentation must include a one-page essay to the committee explaining why the candidate should be considered for the award and that describes the importance of their past and current research.

• Nomination documentation must include copies of the candidate’s three most significant publications from their current faculty position.

• Nomination documentation must include a letter of recommendation from the candidate’s department chair. Up to three additional letters of recommendation will be accepted.

• Nomination documentation includes an NIH-formatted biographical sketch though the electronic application system.

Special consideration will be given to surgeons who are at the “tipping point” of their research careers, with a track record indicative of early promise and potential (for example, a degree program in research or a K-award).

To be considered for the award in 2018, applications must be submitted to facs.org/jpia on or before February 23, 2018.

Additional details

For more information about the award, go to facs.org/jpia.

See a list of all past recipients at facs.org/quality-programs/about/cqi/jacobson/past-recipients.

Send comments and inquiries to Jorge Hernandez, Project Coordinator, Division of Research and Optimal Patient Care—Continuous Quality Improvement, at [email protected] or call 331-202-5319.

The American College of Surgeons (ACS) is accepting applications for the 2018 Joan L. and Julius H. Jacobson II Promising Investigator Award (JPIA) through February 23.

The JPIA was established to recognize outstanding surgeons who are engaging in research, advancing the art and science of surgery, and demonstrating early promise of significant contribution to the practice of surgery and the safety of surgical patients. The award is supported through a generous endowed fund established by the donors and administered by the ACS Surgical Research Committee.
 

Award criteria

The criteria for selection of the JPIA winner are as follows:

• Candidate must be a Fellow or an Associate Fellow of the ACS.

• Candidate must be board certified in a surgical specialty and must have completed surgical training, including fellowship, in the last six years, excluding military, medical, or family leave.

• Candidate must hold a faculty appointment at a research-based academic medical center or hold a military service position.

• Candidate must have received peer-reviewed funding, such as a K-series award from the National Institutes of Health (NIH), Veterans Administration, National Science Foundation, or U.S. Department of Defense merit review award to support their research effort. Surgeon-scientists who are well established (for example, recipients of NIH R01 and Veterans Affairs Merit grants or equivalent grants from other agencies) are ineligible.

• Only one application per surgical department will be accepted.

• Nomination documentation must include a one-page essay to the committee explaining why the candidate should be considered for the award and that describes the importance of their past and current research.

• Nomination documentation must include copies of the candidate’s three most significant publications from their current faculty position.

• Nomination documentation must include a letter of recommendation from the candidate’s department chair. Up to three additional letters of recommendation will be accepted.

• Nomination documentation includes an NIH-formatted biographical sketch though the electronic application system.

Special consideration will be given to surgeons who are at the “tipping point” of their research careers, with a track record indicative of early promise and potential (for example, a degree program in research or a K-award).

To be considered for the award in 2018, applications must be submitted to facs.org/jpia on or before February 23, 2018.

Additional details

For more information about the award, go to facs.org/jpia.

See a list of all past recipients at facs.org/quality-programs/about/cqi/jacobson/past-recipients.

Send comments and inquiries to Jorge Hernandez, Project Coordinator, Division of Research and Optimal Patient Care—Continuous Quality Improvement, at [email protected] or call 331-202-5319.

The American College of Surgeons (ACS) is accepting applications for the 2018 Joan L. and Julius H. Jacobson II Promising Investigator Award (JPIA) through February 23.

The JPIA was established to recognize outstanding surgeons who are engaging in research, advancing the art and science of surgery, and demonstrating early promise of significant contribution to the practice of surgery and the safety of surgical patients. The award is supported through a generous endowed fund established by the donors and administered by the ACS Surgical Research Committee.
 

Award criteria

The criteria for selection of the JPIA winner are as follows:

• Candidate must be a Fellow or an Associate Fellow of the ACS.

• Candidate must be board certified in a surgical specialty and must have completed surgical training, including fellowship, in the last six years, excluding military, medical, or family leave.

• Candidate must hold a faculty appointment at a research-based academic medical center or hold a military service position.

• Candidate must have received peer-reviewed funding, such as a K-series award from the National Institutes of Health (NIH), Veterans Administration, National Science Foundation, or U.S. Department of Defense merit review award to support their research effort. Surgeon-scientists who are well established (for example, recipients of NIH R01 and Veterans Affairs Merit grants or equivalent grants from other agencies) are ineligible.

• Only one application per surgical department will be accepted.

• Nomination documentation must include a one-page essay to the committee explaining why the candidate should be considered for the award and that describes the importance of their past and current research.

• Nomination documentation must include copies of the candidate’s three most significant publications from their current faculty position.

• Nomination documentation must include a letter of recommendation from the candidate’s department chair. Up to three additional letters of recommendation will be accepted.

• Nomination documentation includes an NIH-formatted biographical sketch though the electronic application system.

Special consideration will be given to surgeons who are at the “tipping point” of their research careers, with a track record indicative of early promise and potential (for example, a degree program in research or a K-award).

To be considered for the award in 2018, applications must be submitted to facs.org/jpia on or before February 23, 2018.

Additional details

For more information about the award, go to facs.org/jpia.

See a list of all past recipients at facs.org/quality-programs/about/cqi/jacobson/past-recipients.

Send comments and inquiries to Jorge Hernandez, Project Coordinator, Division of Research and Optimal Patient Care—Continuous Quality Improvement, at [email protected] or call 331-202-5319.

While basking in the fading glow of the holidays, I have been reflecting on the dynamic of stressful professional lives of surgeons combined with the negativity local and world events engender that can push us toward burnout.

The holiday season is a time when people tend to engage in activities that have been shown to improve mood and outlook: connecting with old friends, sharing memories of a happier time, spending time with children and grandchildren, sitting around a warm fire, enjoying the sights and smells of bright decorations and fragrant candles, attending traditional holiday plays, concerts, and ballets. The holiday traditions, no matter what your ethnic or religious background, create community and warm feelings. The workweek may be shortened, people take a little time out, smile a bit more. For many of us, these activities can be a tonic.

At the same time, the days become shorter, colder, and grayer in most of North America. The normal frustrations of our day-to-day professional lives may seem more profound during the winter, and some experience SAD (seasonal affective disorder) or even burnout.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

While basking in the fading glow of the holidays, I have been reflecting on the dynamic of stressful professional lives of surgeons combined with the negativity local and world events engender that can push us toward burnout.

The holiday season is a time when people tend to engage in activities that have been shown to improve mood and outlook: connecting with old friends, sharing memories of a happier time, spending time with children and grandchildren, sitting around a warm fire, enjoying the sights and smells of bright decorations and fragrant candles, attending traditional holiday plays, concerts, and ballets. The holiday traditions, no matter what your ethnic or religious background, create community and warm feelings. The workweek may be shortened, people take a little time out, smile a bit more. For many of us, these activities can be a tonic.

At the same time, the days become shorter, colder, and grayer in most of North America. The normal frustrations of our day-to-day professional lives may seem more profound during the winter, and some experience SAD (seasonal affective disorder) or even burnout.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

While basking in the fading glow of the holidays, I have been reflecting on the dynamic of stressful professional lives of surgeons combined with the negativity local and world events engender that can push us toward burnout.

The holiday season is a time when people tend to engage in activities that have been shown to improve mood and outlook: connecting with old friends, sharing memories of a happier time, spending time with children and grandchildren, sitting around a warm fire, enjoying the sights and smells of bright decorations and fragrant candles, attending traditional holiday plays, concerts, and ballets. The holiday traditions, no matter what your ethnic or religious background, create community and warm feelings. The workweek may be shortened, people take a little time out, smile a bit more. For many of us, these activities can be a tonic.

At the same time, the days become shorter, colder, and grayer in most of North America. The normal frustrations of our day-to-day professional lives may seem more profound during the winter, and some experience SAD (seasonal affective disorder) or even burnout.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

WASHINGTON, DC—Medical marijuana may be an effective therapy for patients with medically refractory epilepsy, according to research presented at the 71st Annual Meeting of the American Epilepsy Society. When combined with current antiepileptic drugs, medical marijuna appears to improve epilepsy, overall quality of life, mood, quality of sleep, and appetite. Most patients report that medical marijuana treatment is more expensive and more inconvenient than antiepileptic drugs, however.

Approximately one-third of patients with epilepsy have medically refractory epilepsy, which is characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life. These patients often have multiple comorbidities that significantly affect their quality of life. New developments in antiepileptic drugs have not significantly reduced the number of patients with medically refractory epilepsy, nor significantly improved quality of life.

Evaluating Efficacy of the New York Medical Marijuana Program

Studies have suggested that cannabidiol (CBD) is effective and well tolerated in patients with medically refractory epilepsy. Juliann M. Paolicchi, MD, Codirector of Pediatric Epilepsy Research for the Northeast Regional Epilepsy Group in New York, and Aidan Papalia, Behavioral Economics Research Assistant at Binghamton University in Rochester, New York, sought to evaluate the potential benefits and disadvantages of the New York Medical Marijuana Program.

The investigators included in their study 27 patients between ages 3 and 48 who had registered for the New York Medical Marijuana Program in the previous year. Participants were required to have used medical marijuana for at least one month.

The average number of previously used antiepileptic drugs was 5.43 in this cohort, and patients were registered to use a 20:1 ratio of CBD to tetrahydrocannabinol.

Patients completed a questionnaire that asked about the effect of marijuana on overall quality of life, epilepsy, and comorbidities (eg, mood, sleep, appetite, stress, sedation, anxiety, and aggression). Patients were also asked to compare the cost and convenience of obtaining medical marijuana with those of previously used antiepileptic medications. Respondents used a scale of 1 (indicating a significant negative impact) to 5 (indicating a significant positive impact).

In all, 17 patients reported medical marijuana use for more than one month, four patients were unable to afford treatment, four participants declined to answer the survey, and two patients were exempt from the study because their contact information had changed or because they had used medical marijuana for less than a month. One patient discontinued therapy for lack of efficacy.

Treatment Improved Quality of Life

Overall, most patients (ie, 70% or more) reported that medical marijuana improved their overall quality of life, epilepsy, mood, quality of sleep, and appetite. Less than half of patients reported improvement in stress, sedation, anxiety, and aggression. In addition, high out-of-pocket costs and lack of insurance coverage of medical marijuana presented major concerns for these patients, said Dr. Paolicchi and Mr. Papalia.

“Although this study lacks controls and is based on self-reporting, it serves as a pilot study for a larger follow-up study to quantify the effects of medical marijuana treatment on medically refractory epilepsy and its associated comorbidities,” they concluded.

—Erica Tricarico

WASHINGTON, DC—Medical marijuana may be an effective therapy for patients with medically refractory epilepsy, according to research presented at the 71st Annual Meeting of the American Epilepsy Society. When combined with current antiepileptic drugs, medical marijuna appears to improve epilepsy, overall quality of life, mood, quality of sleep, and appetite. Most patients report that medical marijuana treatment is more expensive and more inconvenient than antiepileptic drugs, however.

Approximately one-third of patients with epilepsy have medically refractory epilepsy, which is characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life. These patients often have multiple comorbidities that significantly affect their quality of life. New developments in antiepileptic drugs have not significantly reduced the number of patients with medically refractory epilepsy, nor significantly improved quality of life.

Evaluating Efficacy of the New York Medical Marijuana Program

Studies have suggested that cannabidiol (CBD) is effective and well tolerated in patients with medically refractory epilepsy. Juliann M. Paolicchi, MD, Codirector of Pediatric Epilepsy Research for the Northeast Regional Epilepsy Group in New York, and Aidan Papalia, Behavioral Economics Research Assistant at Binghamton University in Rochester, New York, sought to evaluate the potential benefits and disadvantages of the New York Medical Marijuana Program.

The investigators included in their study 27 patients between ages 3 and 48 who had registered for the New York Medical Marijuana Program in the previous year. Participants were required to have used medical marijuana for at least one month.

The average number of previously used antiepileptic drugs was 5.43 in this cohort, and patients were registered to use a 20:1 ratio of CBD to tetrahydrocannabinol.

Patients completed a questionnaire that asked about the effect of marijuana on overall quality of life, epilepsy, and comorbidities (eg, mood, sleep, appetite, stress, sedation, anxiety, and aggression). Patients were also asked to compare the cost and convenience of obtaining medical marijuana with those of previously used antiepileptic medications. Respondents used a scale of 1 (indicating a significant negative impact) to 5 (indicating a significant positive impact).

In all, 17 patients reported medical marijuana use for more than one month, four patients were unable to afford treatment, four participants declined to answer the survey, and two patients were exempt from the study because their contact information had changed or because they had used medical marijuana for less than a month. One patient discontinued therapy for lack of efficacy.

Treatment Improved Quality of Life

Overall, most patients (ie, 70% or more) reported that medical marijuana improved their overall quality of life, epilepsy, mood, quality of sleep, and appetite. Less than half of patients reported improvement in stress, sedation, anxiety, and aggression. In addition, high out-of-pocket costs and lack of insurance coverage of medical marijuana presented major concerns for these patients, said Dr. Paolicchi and Mr. Papalia.

“Although this study lacks controls and is based on self-reporting, it serves as a pilot study for a larger follow-up study to quantify the effects of medical marijuana treatment on medically refractory epilepsy and its associated comorbidities,” they concluded.

—Erica Tricarico

WASHINGTON, DC—Medical marijuana may be an effective therapy for patients with medically refractory epilepsy, according to research presented at the 71st Annual Meeting of the American Epilepsy Society. When combined with current antiepileptic drugs, medical marijuna appears to improve epilepsy, overall quality of life, mood, quality of sleep, and appetite. Most patients report that medical marijuana treatment is more expensive and more inconvenient than antiepileptic drugs, however.

Approximately one-third of patients with epilepsy have medically refractory epilepsy, which is characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life. These patients often have multiple comorbidities that significantly affect their quality of life. New developments in antiepileptic drugs have not significantly reduced the number of patients with medically refractory epilepsy, nor significantly improved quality of life.

Evaluating Efficacy of the New York Medical Marijuana Program

Studies have suggested that cannabidiol (CBD) is effective and well tolerated in patients with medically refractory epilepsy. Juliann M. Paolicchi, MD, Codirector of Pediatric Epilepsy Research for the Northeast Regional Epilepsy Group in New York, and Aidan Papalia, Behavioral Economics Research Assistant at Binghamton University in Rochester, New York, sought to evaluate the potential benefits and disadvantages of the New York Medical Marijuana Program.

The investigators included in their study 27 patients between ages 3 and 48 who had registered for the New York Medical Marijuana Program in the previous year. Participants were required to have used medical marijuana for at least one month.

The average number of previously used antiepileptic drugs was 5.43 in this cohort, and patients were registered to use a 20:1 ratio of CBD to tetrahydrocannabinol.

Patients completed a questionnaire that asked about the effect of marijuana on overall quality of life, epilepsy, and comorbidities (eg, mood, sleep, appetite, stress, sedation, anxiety, and aggression). Patients were also asked to compare the cost and convenience of obtaining medical marijuana with those of previously used antiepileptic medications. Respondents used a scale of 1 (indicating a significant negative impact) to 5 (indicating a significant positive impact).

In all, 17 patients reported medical marijuana use for more than one month, four patients were unable to afford treatment, four participants declined to answer the survey, and two patients were exempt from the study because their contact information had changed or because they had used medical marijuana for less than a month. One patient discontinued therapy for lack of efficacy.

Treatment Improved Quality of Life

Overall, most patients (ie, 70% or more) reported that medical marijuana improved their overall quality of life, epilepsy, mood, quality of sleep, and appetite. Less than half of patients reported improvement in stress, sedation, anxiety, and aggression. In addition, high out-of-pocket costs and lack of insurance coverage of medical marijuana presented major concerns for these patients, said Dr. Paolicchi and Mr. Papalia.

“Although this study lacks controls and is based on self-reporting, it serves as a pilot study for a larger follow-up study to quantify the effects of medical marijuana treatment on medically refractory epilepsy and its associated comorbidities,” they concluded.

—Erica Tricarico

A wearable surface electromyographic (sEMG) monitoring device may help to detect generalized tonic-clonic seizures (GTCS), according to research published in the November 2017 issue of Epilepsia. The monitoring system provides timely detection of GTCS within an average of 7.7 seconds of the onset of bilateral appendicular tonic motor manifestations.

“Since GTCS can cause patient injury and are associated with SUDEP, the [wearable] device should be useful to provide a method for caretakers to check on patient safety shortly after a GTCS,” said Jonathan J. Halford, MD, Associate Professor of Neurology at the Medical University of South Carolina in Charleston.

Evaluating Device Performance and Tolerability

A previous single-site study of an sEMG detection algorithm in an epilepsy monitoring unit detected 95% of 20 GTCS recorded in 11 epilepsy patients with one false positive. To evaluate the performance and tolerability in the epilepsy monitoring unit of an investigational wearable sEMG monitoring system for the detection of GTCS, Dr. Halford and colleagues conducted a prospective, multicenter phase III trial.

One hundred ninety-nine participants ranging in age from 3 to 72 with a history of GTCS (either primary GTCS or partial onset seizures with secondary generalization) and an upper-arm circumference adequate for proper fit of the device were included in the study. Participants had been admitted to an epilepsy monitoring unit for standard clinical care.

Researchers used a custom-designed device to record sEMG data. Recording electrodes were placed transversely over the belly of the biceps brachii muscle. The reference electrode was positioned proximally. The device was taken off and replaced every 12 hours during battery changes. In addition, patients were questioned once daily about adverse events, and skin in contact with the device was examined. Recorded sEMG data were processed at a central site using a previously developed detection algorithm. Finally, detected GTCS were compared with events confirmed by three expert reviewers.

Device Detected Most GTCS

For all participants, the detection algorithm detected 35 of 46 GTCS (ie, 76%), with a positive predictive value of 0.03 and a mean false alarm rate of 2.52 per 24 hours. When the device was placed over the midline of the biceps, the system detected 29 of 29 GTCS with a detection delay average of 7.70 seconds, a positive predictive value of 6.2%, and a mean false alarm rate of 1.44 per 24 hours.

When the device was placed between the biceps and triceps, it caused in-phase cancellation, significantly weakening the sEMG signal. After this discovery, all staff at all study sites were retrained to place the device over the midline biceps. Sixty-four percent of false alarms occurred during activity, and 62% of false alarms contained signal artifact commonly associated with loose electrodes, said the researchers.

Adverse Events and Study Limitations

Mild to moderate adverse events were reported in 28% of participants and led to withdrawal in 9%. Most adverse events consisted of skin irritation from the electrode patch (eg, skin tears, general discomfort, blisters, and bruising). No serious adverse events were reported.

In all, 23% of respondents said that the device was uncomfortable to sleep with. Forty-two percent of these participants reported that they would ask their physician to prescribe the system, and 26% reported that they would not. Thirteen percent of respondents had no opinion, and 18% did not comment.

One study limitation was the initially improper placement of the device. Furthermore, although this study shows that this system works in the epilepsy monitoring unit, it is unclear whether this device will work in the home environment.

In future research, Dr. Halford intends to study the sEMG signal from the scalp, recorded as part of standard EEG, to determine whether it could be used to detect GTCS during ambulatory or inpatient monitoring. He also plans to investigate ways to improve the tolerability of the sEMG monitoring device.

—Erica Tricarico

Suggested Reading

Halford JJ, Sperling MR, Nair DR, et al. Detection of generalized tonic-clonic seizures using surface electromyographic monitoring. Epilepsia. 2017;58(11):1861-1869.

A wearable surface electromyographic (sEMG) monitoring device may help to detect generalized tonic-clonic seizures (GTCS), according to research published in the November 2017 issue of Epilepsia. The monitoring system provides timely detection of GTCS within an average of 7.7 seconds of the onset of bilateral appendicular tonic motor manifestations.

“Since GTCS can cause patient injury and are associated with SUDEP, the [wearable] device should be useful to provide a method for caretakers to check on patient safety shortly after a GTCS,” said Jonathan J. Halford, MD, Associate Professor of Neurology at the Medical University of South Carolina in Charleston.

Evaluating Device Performance and Tolerability

A previous single-site study of an sEMG detection algorithm in an epilepsy monitoring unit detected 95% of 20 GTCS recorded in 11 epilepsy patients with one false positive. To evaluate the performance and tolerability in the epilepsy monitoring unit of an investigational wearable sEMG monitoring system for the detection of GTCS, Dr. Halford and colleagues conducted a prospective, multicenter phase III trial.

One hundred ninety-nine participants ranging in age from 3 to 72 with a history of GTCS (either primary GTCS or partial onset seizures with secondary generalization) and an upper-arm circumference adequate for proper fit of the device were included in the study. Participants had been admitted to an epilepsy monitoring unit for standard clinical care.

Researchers used a custom-designed device to record sEMG data. Recording electrodes were placed transversely over the belly of the biceps brachii muscle. The reference electrode was positioned proximally. The device was taken off and replaced every 12 hours during battery changes. In addition, patients were questioned once daily about adverse events, and skin in contact with the device was examined. Recorded sEMG data were processed at a central site using a previously developed detection algorithm. Finally, detected GTCS were compared with events confirmed by three expert reviewers.

Device Detected Most GTCS

For all participants, the detection algorithm detected 35 of 46 GTCS (ie, 76%), with a positive predictive value of 0.03 and a mean false alarm rate of 2.52 per 24 hours. When the device was placed over the midline of the biceps, the system detected 29 of 29 GTCS with a detection delay average of 7.70 seconds, a positive predictive value of 6.2%, and a mean false alarm rate of 1.44 per 24 hours.

When the device was placed between the biceps and triceps, it caused in-phase cancellation, significantly weakening the sEMG signal. After this discovery, all staff at all study sites were retrained to place the device over the midline biceps. Sixty-four percent of false alarms occurred during activity, and 62% of false alarms contained signal artifact commonly associated with loose electrodes, said the researchers.

Adverse Events and Study Limitations

Mild to moderate adverse events were reported in 28% of participants and led to withdrawal in 9%. Most adverse events consisted of skin irritation from the electrode patch (eg, skin tears, general discomfort, blisters, and bruising). No serious adverse events were reported.

In all, 23% of respondents said that the device was uncomfortable to sleep with. Forty-two percent of these participants reported that they would ask their physician to prescribe the system, and 26% reported that they would not. Thirteen percent of respondents had no opinion, and 18% did not comment.

One study limitation was the initially improper placement of the device. Furthermore, although this study shows that this system works in the epilepsy monitoring unit, it is unclear whether this device will work in the home environment.

In future research, Dr. Halford intends to study the sEMG signal from the scalp, recorded as part of standard EEG, to determine whether it could be used to detect GTCS during ambulatory or inpatient monitoring. He also plans to investigate ways to improve the tolerability of the sEMG monitoring device.

—Erica Tricarico

Suggested Reading

Halford JJ, Sperling MR, Nair DR, et al. Detection of generalized tonic-clonic seizures using surface electromyographic monitoring. Epilepsia. 2017;58(11):1861-1869.

A wearable surface electromyographic (sEMG) monitoring device may help to detect generalized tonic-clonic seizures (GTCS), according to research published in the November 2017 issue of Epilepsia. The monitoring system provides timely detection of GTCS within an average of 7.7 seconds of the onset of bilateral appendicular tonic motor manifestations.

“Since GTCS can cause patient injury and are associated with SUDEP, the [wearable] device should be useful to provide a method for caretakers to check on patient safety shortly after a GTCS,” said Jonathan J. Halford, MD, Associate Professor of Neurology at the Medical University of South Carolina in Charleston.

Evaluating Device Performance and Tolerability

A previous single-site study of an sEMG detection algorithm in an epilepsy monitoring unit detected 95% of 20 GTCS recorded in 11 epilepsy patients with one false positive. To evaluate the performance and tolerability in the epilepsy monitoring unit of an investigational wearable sEMG monitoring system for the detection of GTCS, Dr. Halford and colleagues conducted a prospective, multicenter phase III trial.

One hundred ninety-nine participants ranging in age from 3 to 72 with a history of GTCS (either primary GTCS or partial onset seizures with secondary generalization) and an upper-arm circumference adequate for proper fit of the device were included in the study. Participants had been admitted to an epilepsy monitoring unit for standard clinical care.

Researchers used a custom-designed device to record sEMG data. Recording electrodes were placed transversely over the belly of the biceps brachii muscle. The reference electrode was positioned proximally. The device was taken off and replaced every 12 hours during battery changes. In addition, patients were questioned once daily about adverse events, and skin in contact with the device was examined. Recorded sEMG data were processed at a central site using a previously developed detection algorithm. Finally, detected GTCS were compared with events confirmed by three expert reviewers.

Device Detected Most GTCS

For all participants, the detection algorithm detected 35 of 46 GTCS (ie, 76%), with a positive predictive value of 0.03 and a mean false alarm rate of 2.52 per 24 hours. When the device was placed over the midline of the biceps, the system detected 29 of 29 GTCS with a detection delay average of 7.70 seconds, a positive predictive value of 6.2%, and a mean false alarm rate of 1.44 per 24 hours.

When the device was placed between the biceps and triceps, it caused in-phase cancellation, significantly weakening the sEMG signal. After this discovery, all staff at all study sites were retrained to place the device over the midline biceps. Sixty-four percent of false alarms occurred during activity, and 62% of false alarms contained signal artifact commonly associated with loose electrodes, said the researchers.

Adverse Events and Study Limitations

Mild to moderate adverse events were reported in 28% of participants and led to withdrawal in 9%. Most adverse events consisted of skin irritation from the electrode patch (eg, skin tears, general discomfort, blisters, and bruising). No serious adverse events were reported.

In all, 23% of respondents said that the device was uncomfortable to sleep with. Forty-two percent of these participants reported that they would ask their physician to prescribe the system, and 26% reported that they would not. Thirteen percent of respondents had no opinion, and 18% did not comment.

One study limitation was the initially improper placement of the device. Furthermore, although this study shows that this system works in the epilepsy monitoring unit, it is unclear whether this device will work in the home environment.

In future research, Dr. Halford intends to study the sEMG signal from the scalp, recorded as part of standard EEG, to determine whether it could be used to detect GTCS during ambulatory or inpatient monitoring. He also plans to investigate ways to improve the tolerability of the sEMG monitoring device.

—Erica Tricarico

Suggested Reading

Halford JJ, Sperling MR, Nair DR, et al. Detection of generalized tonic-clonic seizures using surface electromyographic monitoring. Epilepsia. 2017;58(11):1861-1869.

A case series of seven girls with apparent vitiligoid lichen sclerosus supports the possible predisposition of this condition in darker skin types, said Margaret H. Dennin, of the University of Chicago, and her associates.

Vitiligoid lichen sclerosus is a superficial variant of lichen sclerosus (LS), in which the lesion clinically appears to be vitiligo, but histologically is consistent with LS.

Seven dark-skinned girls aged 3-9 years had symptomatic (pruritus, pain, bleeding, constipation) depigmented patches of the vulvar or perianal region; three had purpuric lesions. None of the patients had atrophy or scarring, and they had no depigmentation anywhere else on their bodies. Follow-up was an average 2 years (range 3 months to 4 years).

Treatment with high-potency topical steroids, calcineurin inhibitors, or both resulted in improvement or resolution of their symptoms in all cases, but there was mild or no improvement in the depigmentation. Biopsies were not performed because of the patients’ young age and the location of the lesions, the investigators said.

The term vitiligoid lichen sclerosus was first coined in 1961 by Borda et al. when depigmented patches, as seen in both conditions, constituted the clinical appearance, but lacked the inflammation, atrophy, and sclerosis of typical LS. Histologically, these lesions were like LS, “based on the presence of a thin band of papillary dermal sclerosis,” Ms. Dennin and her associates said. Borda et al. suggested that vitiligoid lichen sclerosus might be limited to dark-skinned people, and recent reports support this. Alternatively, it may be that the depigmentation simply is more obvious on dark-skinned people, and asymptomatic cases go unnoticed on lighter-skinned people, the investigators surmised.

Both vitiligo and LS are autoimmune cutaneous disorders, and they both often affect the anogenital region. The conditions “may be linked through a common autoimmune response from exposed intracellular or altered cell surface antigens on damaged melanocytes,” the investigators said. “Histologic evidence demonstrates that development of vitiligo involves a preceding lichenoid inflammatory reaction that may trigger an autoimmune reaction to melanocytes, decreasing their number. Evolving vitiligo with a lichenoid reaction may result in epitope spreading and the development of LS.”

The study is limited by its retrospective nature, small sample size, and lack of biopsies, the researchers noted. Larger studies are needed to look at the overlap of the conditions, and “understand the true prevalence of vitiligoid lichen sclerosus,” Ms. Dennin and her associates said.

Read more in Pediatric Dermatology (2018. doi: 10.1111/pde.13399).

[email protected]

A case series of seven girls with apparent vitiligoid lichen sclerosus supports the possible predisposition of this condition in darker skin types, said Margaret H. Dennin, of the University of Chicago, and her associates.

Vitiligoid lichen sclerosus is a superficial variant of lichen sclerosus (LS), in which the lesion clinically appears to be vitiligo, but histologically is consistent with LS.

Seven dark-skinned girls aged 3-9 years had symptomatic (pruritus, pain, bleeding, constipation) depigmented patches of the vulvar or perianal region; three had purpuric lesions. None of the patients had atrophy or scarring, and they had no depigmentation anywhere else on their bodies. Follow-up was an average 2 years (range 3 months to 4 years).

Treatment with high-potency topical steroids, calcineurin inhibitors, or both resulted in improvement or resolution of their symptoms in all cases, but there was mild or no improvement in the depigmentation. Biopsies were not performed because of the patients’ young age and the location of the lesions, the investigators said.

The term vitiligoid lichen sclerosus was first coined in 1961 by Borda et al. when depigmented patches, as seen in both conditions, constituted the clinical appearance, but lacked the inflammation, atrophy, and sclerosis of typical LS. Histologically, these lesions were like LS, “based on the presence of a thin band of papillary dermal sclerosis,” Ms. Dennin and her associates said. Borda et al. suggested that vitiligoid lichen sclerosus might be limited to dark-skinned people, and recent reports support this. Alternatively, it may be that the depigmentation simply is more obvious on dark-skinned people, and asymptomatic cases go unnoticed on lighter-skinned people, the investigators surmised.

Both vitiligo and LS are autoimmune cutaneous disorders, and they both often affect the anogenital region. The conditions “may be linked through a common autoimmune response from exposed intracellular or altered cell surface antigens on damaged melanocytes,” the investigators said. “Histologic evidence demonstrates that development of vitiligo involves a preceding lichenoid inflammatory reaction that may trigger an autoimmune reaction to melanocytes, decreasing their number. Evolving vitiligo with a lichenoid reaction may result in epitope spreading and the development of LS.”

The study is limited by its retrospective nature, small sample size, and lack of biopsies, the researchers noted. Larger studies are needed to look at the overlap of the conditions, and “understand the true prevalence of vitiligoid lichen sclerosus,” Ms. Dennin and her associates said.

Read more in Pediatric Dermatology (2018. doi: 10.1111/pde.13399).

[email protected]

A case series of seven girls with apparent vitiligoid lichen sclerosus supports the possible predisposition of this condition in darker skin types, said Margaret H. Dennin, of the University of Chicago, and her associates.

Vitiligoid lichen sclerosus is a superficial variant of lichen sclerosus (LS), in which the lesion clinically appears to be vitiligo, but histologically is consistent with LS.

Seven dark-skinned girls aged 3-9 years had symptomatic (pruritus, pain, bleeding, constipation) depigmented patches of the vulvar or perianal region; three had purpuric lesions. None of the patients had atrophy or scarring, and they had no depigmentation anywhere else on their bodies. Follow-up was an average 2 years (range 3 months to 4 years).

Treatment with high-potency topical steroids, calcineurin inhibitors, or both resulted in improvement or resolution of their symptoms in all cases, but there was mild or no improvement in the depigmentation. Biopsies were not performed because of the patients’ young age and the location of the lesions, the investigators said.

The term vitiligoid lichen sclerosus was first coined in 1961 by Borda et al. when depigmented patches, as seen in both conditions, constituted the clinical appearance, but lacked the inflammation, atrophy, and sclerosis of typical LS. Histologically, these lesions were like LS, “based on the presence of a thin band of papillary dermal sclerosis,” Ms. Dennin and her associates said. Borda et al. suggested that vitiligoid lichen sclerosus might be limited to dark-skinned people, and recent reports support this. Alternatively, it may be that the depigmentation simply is more obvious on dark-skinned people, and asymptomatic cases go unnoticed on lighter-skinned people, the investigators surmised.

Both vitiligo and LS are autoimmune cutaneous disorders, and they both often affect the anogenital region. The conditions “may be linked through a common autoimmune response from exposed intracellular or altered cell surface antigens on damaged melanocytes,” the investigators said. “Histologic evidence demonstrates that development of vitiligo involves a preceding lichenoid inflammatory reaction that may trigger an autoimmune reaction to melanocytes, decreasing their number. Evolving vitiligo with a lichenoid reaction may result in epitope spreading and the development of LS.”

The study is limited by its retrospective nature, small sample size, and lack of biopsies, the researchers noted. Larger studies are needed to look at the overlap of the conditions, and “understand the true prevalence of vitiligoid lichen sclerosus,” Ms. Dennin and her associates said.

Read more in Pediatric Dermatology (2018. doi: 10.1111/pde.13399).

[email protected]

The Diagnosis: Dermatofibroma

On dermoscopy, a central stellate, white, scarlike patch was seen (Figure). On both legs the patient had several additional brown 5- to 7-mm papules with similar dermoscopic features.

Dermatofibromas are common benign fibrosing tumors that appear as firm papules or plaques with variable color, commonly on the legs. Typically, lateral compression of a dermatofibroma causes downward displacement, called a positive dimple sign. On histology, fibroblasts and myofibroblasts can be seen as short intersecting fascicles with variable inflammatory cells and induction of adjacent structure hyperplasia. The etiology of dermatofibromas is unclear, though some are thought to be secondary to trauma or arthropod bites.¹ Because these tumors are benign, the correct diagnosis can avoid unnecessary biopsies or other procedures.

The dermoscopic features of dermatofibromas have been well established.² As perhaps the most easily identified structure, scarlike patches were seen in as many as 92% (22/24) of dermatofibromas in one study by Ferarri et al,³ while pigment networks also are commonly seen.² In our case, given the surrounding dense tattoo deposition, it was difficult to ascertain any pigment network. However, the scarlike central patch was clearly apparent by dermoscopy.

Because dermatofibromas are hypothesized to be secondary to trauma, presumably applying tattoos also may cause dermatofibromas. Limited cases have described dermatofibromas arising in tattoos applied several months to years prior.^4-6 No prior cases utilized dermoscopy. In our case, clinical examination and dermoscopy clearly demonstrated features consistent with a dermatofibroma, and the patient had more characteristic dermatofibromas scattered elsewhere on both legs. The patient was reassured that the lesions were benign and that the depigmentation was likely secondary to the process of dermatofibroma growth. She declined any treatment.

The Diagnosis: Dermatofibroma

On dermoscopy, a central stellate, white, scarlike patch was seen (Figure). On both legs the patient had several additional brown 5- to 7-mm papules with similar dermoscopic features.

Dermatofibromas are common benign fibrosing tumors that appear as firm papules or plaques with variable color, commonly on the legs. Typically, lateral compression of a dermatofibroma causes downward displacement, called a positive dimple sign. On histology, fibroblasts and myofibroblasts can be seen as short intersecting fascicles with variable inflammatory cells and induction of adjacent structure hyperplasia. The etiology of dermatofibromas is unclear, though some are thought to be secondary to trauma or arthropod bites.¹ Because these tumors are benign, the correct diagnosis can avoid unnecessary biopsies or other procedures.

The dermoscopic features of dermatofibromas have been well established.² As perhaps the most easily identified structure, scarlike patches were seen in as many as 92% (22/24) of dermatofibromas in one study by Ferarri et al,³ while pigment networks also are commonly seen.² In our case, given the surrounding dense tattoo deposition, it was difficult to ascertain any pigment network. However, the scarlike central patch was clearly apparent by dermoscopy.

Because dermatofibromas are hypothesized to be secondary to trauma, presumably applying tattoos also may cause dermatofibromas. Limited cases have described dermatofibromas arising in tattoos applied several months to years prior.^4-6 No prior cases utilized dermoscopy. In our case, clinical examination and dermoscopy clearly demonstrated features consistent with a dermatofibroma, and the patient had more characteristic dermatofibromas scattered elsewhere on both legs. The patient was reassured that the lesions were benign and that the depigmentation was likely secondary to the process of dermatofibroma growth. She declined any treatment.

The Diagnosis: Dermatofibroma

On dermoscopy, a central stellate, white, scarlike patch was seen (Figure). On both legs the patient had several additional brown 5- to 7-mm papules with similar dermoscopic features.

Dermatofibromas are common benign fibrosing tumors that appear as firm papules or plaques with variable color, commonly on the legs. Typically, lateral compression of a dermatofibroma causes downward displacement, called a positive dimple sign. On histology, fibroblasts and myofibroblasts can be seen as short intersecting fascicles with variable inflammatory cells and induction of adjacent structure hyperplasia. The etiology of dermatofibromas is unclear, though some are thought to be secondary to trauma or arthropod bites.¹ Because these tumors are benign, the correct diagnosis can avoid unnecessary biopsies or other procedures.

The dermoscopic features of dermatofibromas have been well established.² As perhaps the most easily identified structure, scarlike patches were seen in as many as 92% (22/24) of dermatofibromas in one study by Ferarri et al,³ while pigment networks also are commonly seen.² In our case, given the surrounding dense tattoo deposition, it was difficult to ascertain any pigment network. However, the scarlike central patch was clearly apparent by dermoscopy.

Because dermatofibromas are hypothesized to be secondary to trauma, presumably applying tattoos also may cause dermatofibromas. Limited cases have described dermatofibromas arising in tattoos applied several months to years prior.^4-6 No prior cases utilized dermoscopy. In our case, clinical examination and dermoscopy clearly demonstrated features consistent with a dermatofibroma, and the patient had more characteristic dermatofibromas scattered elsewhere on both legs. The patient was reassured that the lesions were benign and that the depigmentation was likely secondary to the process of dermatofibroma growth. She declined any treatment.

DENVER – Thirty-day transcatheter aortic valve replacement (TAVR) outcomes in real-world clinical practice using the Evolut R self-expanding valve were as good in patients treated for bicuspid disease as for tricuspid disease, according to a retrospective analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) national registry.

Bruce Jancin/Frontline Medical News

[email protected]

SOURCE: Popma JJ. TCT 2017.

DENVER – Thirty-day transcatheter aortic valve replacement (TAVR) outcomes in real-world clinical practice using the Evolut R self-expanding valve were as good in patients treated for bicuspid disease as for tricuspid disease, according to a retrospective analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) national registry.

Bruce Jancin/Frontline Medical News

[email protected]

SOURCE: Popma JJ. TCT 2017.

DENVER – Thirty-day transcatheter aortic valve replacement (TAVR) outcomes in real-world clinical practice using the Evolut R self-expanding valve were as good in patients treated for bicuspid disease as for tricuspid disease, according to a retrospective analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) national registry.

Bruce Jancin/Frontline Medical News

[email protected]

SOURCE: Popma JJ. TCT 2017.

Desmoplastic melanoma, a rare chemotherapy-resistant cutaneous malignancy, appears to be particularly responsive to immunotherapy with inhibitors of programmed death 1 (PD-1) or PD ligand 1 (PD-L1), investigators found.

Of 60 patients with desmoplastic melanoma (DM) treated with pembrolizumab (Keytruda), nivolumab (Opdivo), or an experimental PD-L1 inhibitor (BMS 936559) and followed for a median of 22 months, 42 (70%) had an objective response to immunotherapy, including 19 patients (32%) with a complete response (CR), and 38% with a partial response, reported Antoni Ribas, MD, PhD, of the University of California, Los Angeles, and colleagues.

SOURCE: Ribas A et al. Nature. 2018 Jan 10. doi: 10.1038/nature25187.

Desmoplastic melanoma, a rare chemotherapy-resistant cutaneous malignancy, appears to be particularly responsive to immunotherapy with inhibitors of programmed death 1 (PD-1) or PD ligand 1 (PD-L1), investigators found.

Of 60 patients with desmoplastic melanoma (DM) treated with pembrolizumab (Keytruda), nivolumab (Opdivo), or an experimental PD-L1 inhibitor (BMS 936559) and followed for a median of 22 months, 42 (70%) had an objective response to immunotherapy, including 19 patients (32%) with a complete response (CR), and 38% with a partial response, reported Antoni Ribas, MD, PhD, of the University of California, Los Angeles, and colleagues.

SOURCE: Ribas A et al. Nature. 2018 Jan 10. doi: 10.1038/nature25187.

Desmoplastic melanoma, a rare chemotherapy-resistant cutaneous malignancy, appears to be particularly responsive to immunotherapy with inhibitors of programmed death 1 (PD-1) or PD ligand 1 (PD-L1), investigators found.

Of 60 patients with desmoplastic melanoma (DM) treated with pembrolizumab (Keytruda), nivolumab (Opdivo), or an experimental PD-L1 inhibitor (BMS 936559) and followed for a median of 22 months, 42 (70%) had an objective response to immunotherapy, including 19 patients (32%) with a complete response (CR), and 38% with a partial response, reported Antoni Ribas, MD, PhD, of the University of California, Los Angeles, and colleagues.

SOURCE: Ribas A et al. Nature. 2018 Jan 10. doi: 10.1038/nature25187.