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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_438"
                     title="Rituximab Shows Promise in Scleroderma (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/tb/18352?impressionId=1265779775581"
                     
      &lt;p&gt;Rituximab (Rituxan) improved lung function in patients with scleroderma, a small proof-of-principle study found.&lt;/p&gt;
&lt;p&gt;At one year, patients randomized to receive rituximab had a median 10.25% increase in forced vital capacity (FVC) compared with baseline, while those who received standard treatment had a deterioration of 5.04% (&lt;em&gt;P&lt;/em&gt;=0.002), according to Dimitrios Daoussis, MD, and colleagues from the University of Patras in Greece.&lt;/p&gt;
&lt;p&gt;There also was a significant 19.46% increase in diffusing capacity of carbon monoxide (DL&lt;sub&gt;co&lt;/sub&gt;) in the rituximab-treated patients, while the controls showed deterioration of 7.5% (&lt;em&gt;P&lt;/em&gt;=0.023), the researchers reported in the February issue of &lt;em&gt;Rheumatology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Interstitial lung disease is a common manifestation of diffuse scleroderma and represents the disease component that dictates prognosis because it can be progressive and typically responds poorly to treatment. Animal and human studies have suggested a possible pathogenic role for B cells in the disease.&lt;/p&gt;
&lt;p&gt;There have been a few reports of clinical and histologic improvements in scleroderma and in graft-versus-host disease (which shares some features with scleroderma) after treatment with the B-cell depleting monoclonal antibody rituximab.&lt;/p&gt;
&lt;p&gt;These encouraging early findings led Daoussis and colleagues to undertake an open-label, controlled study that included 14 patients with diffuse disease.&lt;/p&gt;
&lt;p&gt;Median age was 55 and mean disease duration was seven years.&lt;/p&gt;
&lt;p&gt;All patients continued their standard medications, which included various agents such as prednisone, bosentan (Tracleer), mycophenolate mofetil (CellCept), and cyclophosphamide.&lt;/p&gt;
&lt;p&gt;Those randomized to rituximab treatment also underwent four weekly pulses of the drug (375 mg/m&lt;sup&gt;2&lt;/sup&gt;) at baseline and six months later.&lt;/p&gt;
&lt;p&gt;By one year, the mean FVC in the rituximab group had risen from 68.13% of normal predicted value based on age, sex, and height, to 75.63% (&lt;em&gt;P&lt;/em&gt;=0.0018), while FVC in the control group fell nonsignificantly from 86% of normal to 81.67%.&lt;/p&gt;
&lt;p&gt;In the rituximab group, DL&lt;sub&gt;co&lt;/sub&gt; increased from a mean of 52.25% of normal at baseline to 62% (&lt;em&gt;P&lt;/em&gt;=0.017) at one year, while the controls decreased nonsignificantly from 65.33% to 60.17%.&lt;/p&gt;
&lt;p&gt;None of the patients treated with rituximab experienced worsening of FVC or DL&lt;sub&gt;co&lt;/sub&gt;, whereas lung function deteriorated in five controls.&lt;/p&gt;
&lt;p&gt;&quot;We should note, however, that patients in the control group tended to have more early disease and better lung function parameters (although not statistically different from the [rituximab] group) making them more likely to deteriorate over the time of the study,&quot; the investigators commented.&lt;/p&gt;
&lt;p&gt;Skin manifestations of the disease also showed improvements in the rituximab group. Skin thickening, as measured by the Modified Rodnan Skin Score, improved by 39.25% in the rituximab group and by 20.80% in the control group, a difference that was not statistically significant.&lt;/p&gt;
&lt;p&gt;Skin fibrosis also improved by a median of 38.33%, while it worsened by 5.23% in controls.&lt;/p&gt;
&lt;p&gt;Histologic improvement was seen in four of the rituximab-treated patients, corresponding with clinical benefits. One patient in the active treatment group had a significant reduction of fibrosis in both the papillary and reticular dermis, accompanied by an almost complete resolution of skin lesions.&lt;/p&gt;
&lt;p&gt;Improvement in skin fibrosis was most common in patients who had evidence of B-cell depletion in the skin.&lt;/p&gt;
&lt;p&gt;Overall function, as evaluated by the Health Assessment Questionnaire, improved from a median baseline score of 0.687 to 0.312 at one year (&lt;em&gt;P&lt;/em&gt;=0.03), while no change was seen in controls.&lt;/p&gt;
&lt;p&gt;The pathogenesis of scleroderma is poorly understood, according to the authors, but this study adds support to a possible role for B cells.&lt;/p&gt;
&lt;p&gt;In addition, rituximab indirectly targets T cells, which also are thought to be implicated.&lt;/p&gt;
&lt;p&gt;The authors noted potential limitations, including the study&apos;s small size and the fact that most patients had longstanding disease, had been treated with multiple immunosuppressive agents in the past, and were receiving concurrent therapies during the study.&lt;/p&gt;
&lt;p&gt;&quot;This is a proof-of-principle study that was performed in order to obtain preliminary data regarding the effect of [rituximab] on a limited number of patients,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Our data could serve as a good starting point for the design of larger scale, multicenter studies with longer evaluation periods and especially in earlier stages of the disease,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Robert W. Simms, MD, and Robert Lafyatis, MD, of Boston University, echoed concerns about the small number of patients and the lack of blinding in the study.&lt;/p&gt;
&lt;p&gt;&quot;One cannot...on the basis of this study, recommend rituximab in the routine clinical care of patients with scleroderma,&quot; the editorialists wrote.&lt;/p&gt;
&lt;p&gt;The findings will need to be replicated in a multicenter randomized trial, but &quot;do provide some hope that B-cell depletion might enhance the currently restricted therapeutic armamentarium of this disease.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Hellenic Rheumatology Society.&lt;/p&gt;&lt;p&gt;Funding to pay Open Access publication charges was provided by Roche Hellas.&lt;/p&gt;&lt;p&gt;Authors and editorialists declared to conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265779775581"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1446"
                     title="SID: Actinic Keratoses Have Cyclic Nature"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14130?impressionId=1265779775581"
                     
       MONTREAL, May 8 -- Actinic keratoses are dynamic lesions with intermittent expression in subjects with even extensive damage, according to an 11-month study of their natural course. 
              &lt;p&gt;&quot;At any one time, less than half of the lesions are present clinically,&quot; said Craig Elmets, M.D., who reported his findings here at the Society for Investigative Dermatology meeting. 
              &lt;p&gt;The frequent regression and recurrence of lesions has implications for the treatment of actinic keratoses (AK), which are precursors to squamous cell carcinomas, said Dr. Elmets, of the University of Alabama in Birmingham. 
              &lt;p&gt;&quot;In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions,&quot; Dr. Elmets said. &quot;If one is going to treat individual lesions, then they need to be treated very aggressively because at any one time only a minority of the AK are present.&quot; 
              &lt;p&gt;Dr. Elmets and colleagues followed AK lesions in 26 individuals with extensive actinic damage. At baseline, the study participants had between 10 and 40 actinic lesions and at least one prior histological diagnosis of an AK or nonmelanoma skin cancer. 
              &lt;p&gt;Mapping of the lesions was done at baseline and again at three, six, nine, and 11 months. The lesions were also biopsied at both baseline and the end of the study. 
              &lt;p&gt;&quot;If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,&quot; Dr. Elmets explained. 
              &lt;p&gt;At baseline, there was a total number of 610 AKs in the study group (mean 23.5 per individual), and this number was not significantly different at the end of the study, despite the development of 973 new lesions over the 11-month period. 
              &lt;p&gt;About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, Dr. Elmets said. &quot;A total of 51 of the lesions regressed twice.&quot; 
              &lt;p&gt;Using a histologic grading scheme that was based on a cervical dysplasia model, he noted little progression in severity of lesions in terms of proliferation, atypia, or both. 
              &lt;p&gt;&quot;The histologic appearance seems to accurately correlate with the clinical appearance, and over the course of 11 months there was little evidence of histologic progression,&quot; he said. 
              &lt;p&gt;AK lesions have strong predictive value for individuals who will eventually develop basal cell or squamous cell carcinomas,&quot; Dr. Elmets said, &quot;but until now their natural history has not been well understood.&quot;   
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Elmets did not disclose any conflicts of interest or funding for the study.  &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1453"
                     title="SID: Melanoma in U.S. Shows Rapid Increase"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14141?impressionId=1265779775581"
                     
      MONTREAL, May 11 -- The incidence of melanoma in the U.S. increased rapidly over a 12-year period -- across socioeconomic lines and for all tumor thicknesses -- according to a study reported here. 
              &lt;p&gt;
              &lt;p&gt;During the study period from 1992 to 2004, the incidence of all thicknesses of melanoma increased from 18.2 per 100,000 to 26.3 per 100,000 (95% CI 25.7 to 27.0) -- an annual increase of 3.1% (&lt;em&gt;P&lt;/em&gt;&lt;0.001), the report said. 
              &lt;p&gt;
              &lt;p&gt;A total of 70,596 new cases was reported over the period.
              &lt;p&gt;
              &lt;p&gt;&quot;This has implications for preventive screening and primary care,&quot; Eleni Linos, M.D., Ph.D., of Stanford University Medical Center, told colleagues at the Society for Investigative Dermatology meeting here. 
              &lt;p&gt;
              &lt;p&gt;&quot;We believe this represents a genuine increase in melanoma cases, not just a sign of better screening,&quot; she said in an interview. 
              &lt;p&gt;
              &lt;p&gt;Her study, published in the &lt;em&gt;Journal of&lt;/em&gt; &lt;em&gt;Investigative Dermatology&lt;/em&gt;, examined data from the Surveillance Epidemiology and End Results (SEER) registry between 1992 and 2004. (See: &lt;a href=&quot;http://www.medpagetoday.com/HematologyOncology/SkinCancer/12377&quot; target=&quot;blank&quot;&gt;Reports of Increases in Melanoma Incidence Are Real&lt;/a&gt;). 
              &lt;p&gt;
              &lt;p&gt;The research focused only on non-Hispanic white subjects, in whom 90% of melanomas occur, said Dr. Linos. 
              &lt;p&gt;
              &lt;p&gt;Melanoma affects both sexes, but during the period of the study, cases involving women outnumbered those in men by a 3:2 margin. 
              &lt;p&gt;
              &lt;p&gt;The steepest increase and highest overall incidence occurred in men ages 65 years and older, with the rate rising from 73 to 126 new cases per 100,000 (CI 120.2 to 132.4). Among women the rate was 51 per 100,000 (CI 50.8 (47.5 to 54.2).
              &lt;p&gt; 
              &lt;p&gt;Among those younger than 65 years, incidence rates were 18.8 cases per 100,000 in men (CI 18.0 to 19.6) and 17.9 cases among women (CI 17.1 to 18.7). 
              &lt;p&gt;
              &lt;p&gt;Fortunately, the increase in overall incidence was not matched by an increase in mortality, which rose by 0.4% annually, with a 2% annual rise in older men. 
              &lt;p&gt;
              &lt;p&gt;&quot;The vast majority of melanomas that are diagnosed are thin, and that is why we have not seen such a dramatic increase in mortality rates,&quot; Dr. Linos explained. 
              &lt;p&gt;
              &lt;p&gt;Researchers examined melanoma trends according to socioeconomic status to determine whether the findings could be explained by better screening in those with higher brackets, and by higher mortality rates in those with lower socioeconomic status. 
              &lt;p&gt;
              &lt;p&gt;Similarly, tumor thickness was examined to determine whether the increased incidence could be explained by more diagnoses of thin, clinically insignificant tumors. 
              &lt;p&gt;
              &lt;p&gt;&quot;We found parallel increases across all socioeconomic groups and thicknesses, representing a true increase in clinically significant tumors,&quot; she said. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Linos reported no conflicts of interest. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
    <recommendedItem id="20090101_19_1463"
                     title="SID: COX-2 Inhibitors May Cut Skin Cancer Rate"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SID/tb/14152?impressionId=1265779775581"
                     
       MONTREAL, May 12 -- A twice-daily dose of celecoxib (Celebrex) over a period of nine months reduced the incidence of nonmelanoma skin cancer by almost 60 percent, according a new study. 
              &lt;p&gt;&lt;p&gt;&quot;COX-2 inhibitors are more effective than sunscreens in inhibiting skin cancer development,&quot; Craig Elmets, M.D., of the University of Alabama, told colleagues at the annual meeting of the Society for Investigative Dermatology. 
              &lt;p&gt;The study enrolled 238 patients with actinic keratoses (AK) and a history of nonmelanoma skin cancer or AK from eight U.S. centers. The mean age of the patients was 65 years; they were mostly male, and virtually all were Caucasian, he said. 
              &lt;p&gt;&quot;The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,&quot; he noted. 
              &lt;p&gt;Subjects in the study had Fitzpatrick skin types I to III, extensive actinic damage with between 10 and 40 AK and prior histologic diagnosis of either AK or nonmelanoma skin cancer. 
              &lt;p&gt;They were excluded if they required treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), although cardioprotective doses of aspirin were allowed, he said. 
              &lt;p&gt;At entry, patients had a mean number of 22 AKs, as well as between 2.1 and 2.5 nonmelanoma skin cancers, Dr. Elmets said. 
              &lt;p&gt;Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dose for arthritis. 
              &lt;p&gt;&quot;We were concerned about cardiovascular abnormalities and GI abnormalities, and, if anything, there was a bias towards patients in the celecoxib group having a prior history of that,&quot; he said. 
              &lt;p&gt;Celecoxib had no apparent effect on the number of AKs at baseline versus completion compared to placebo, he noted. 
              &lt;p&gt;But the results were more positive regarding development of new cutaneous basal and squamous cell carcinomas. 
              &lt;p&gt;&quot;We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,&quot; he said. 
              &lt;p&gt;Looking at the two types of lesions separately, treatment with celecoxib resulted in a 58% reduction in squamous cell carcinomas (SCC), and a 62% reduction in basal cell carcinomas (BCC). 
              &lt;p&gt;&quot;The difference between the [placebo and treated] groups started to become apparent quite rapidly, at three months, and persisted throughout the study,&quot; he said. 
              &lt;p&gt;&quot;We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCC and SCC than the placebo group.&quot; 
              &lt;p&gt;There were no differences in adverse events, serious adverse events, or cardiovascular adverse events between the two groups, Dr. Elmets reported, although during the question period he acknowledged higher blood pressures reported in the treatment group. 
              &lt;p&gt;Of the 238 patients enrolled, 36 and 24 withdrew from the treatment and placebo groups respectively. 
              &lt;p&gt;This study suggests that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than sunscreens, which are only &quot;modestly effective,&quot; said Dr. Elmets. 
              &lt;p&gt;&quot;There&apos;s only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a five-year period of time, and there&apos;s no reduction in basal cell carcinomas.&quot; 
              &lt;p&gt;&quot;The data is very compelling,&quot; commented Maryam Asgari, M.D., a Kaiser Permanente dermatologist in Oakland, Calif. who has conducted similar research. But she cautioned that the study might have been too short to warrant dramatic conclusions. 
              &lt;p&gt;&quot;I know that, typically, for most cancers you would need a study to last two to five years before you would expect to measure an effect,&quot; she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop, she suggested. 
              &lt;p&gt;Dr. Asgari said her own research in the same field has produced opposite results, including a recently completed study showing that NSAIDS -- both selective and nonselective COX inhibitors -- had no apparent effect on the incidence of squamous cell carcinoma. 
              &lt;p&gt;She said a previous paper published by her group also found no protective effect of these drugs on melanomas.
              &lt;p class=&quot;MsoNormal&quot;&gt;
              &lt;p&gt;In addition, she said celecoxib&apos;s lack of effect on AKs is a puzzling result. &quot;You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses, because they both share the same pathway.&quot; 
              &lt;p&gt;Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin -- an important factor that the analysis did not adjust for, she pointed out. 
              &lt;p&gt;&quot;Even low dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.&quot; 
              &lt;p&gt;The study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer, through a contractual agreement with the National Institutes of Health. 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Elmets reported no conflict of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>