The policy changes prompted by the COVID-19 pandemic caused synchronous models (primarily video visits) to supplant asynchronous models (store-and-forward or shared digital photographs) as the default and predominant modality of teledermatology care. Here, we call attention to the unique strengths and limitations of these models in terms of clinical utility, accessibility, and cost-effectiveness. Strengths of synchronous visits include direct physician-patient interaction and current reimbursement parity; limitations include variable video image quality, technological difficulties, and accessibility barriers. Strengths of asynchronous visits include greater convenience, especially for clinicians, and potential for image quality superior to video; limitations include less direct physician-patient communication, barriers to follow-up, and limited reimbursement. Both synchronous and asynchronous models have been shown to be cost-effective. Teledermatology is positioned to play a prominent role in patient care post-pandemic. Moving forward, dermatologists are challenged to optimize teledermatology use in order to improve outcomes, efficiency, and workflows to meet diverse patient needs. Future directions will depend on sustainable reimbursement of both teledermatology formats by government and private payers.

BACKGROUND: Surgical treatment is advised for unstable distal clavicle fractures (UDCFs). Various kinds of internal fixation methods have been used, but the best fixation is still controversial.
METHODS: We systematically searched all studies comparing postoperative outcomes of coracoclavicular (CC) reconstruction (TightRope, EndoButton, Mersilene tape, suture anchor or suture), fracture osteosynthesis (clavicular hook plate (HP), locking compression plate (LCP), Kirschner wire and tension band (KWTB), Kirschner wire (KW)), and a combination of the two methods (LCP + CC or KWTB + CC) for UDCF in PubMed, Web of Science Core Collection via Ovid, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and China Biology Medicine (CBM) databases up to September 16, 2021, with no language restrictions. A network meta-analysis (NMA) was conducted to integrate direct and indirect evidence and assess the relative effects of the internal fixation methods. The probability of being the best treatment was assessed by the surface under the cumulative ranking curve (SUCRA).
RESULTS: A total of 41 studies were included, involving 1969 patients and seven internal fixation methods. The NMA showed that LCP + CC fixation was associated with better efficacy (odds ratio (OR) 0.60, 95% CI 0.19-1.02, probability rank = 0.93) and fewer complications (odds ratio (OR) 0.22, 95% CI 0.09-0.51, probability rank = 0.69) than any other internal fixation method for UDCFs. The SUCRA probabilities of LCP + CC fixation were 98.6% for the Constant-Murley score and 93.9% for total complications.
CONCLUSIONS: The results of this study indicate that LCP + CC appears to be the best internal fixation method for UDCF. Limited to the quality and quantity of the included studies, much larger and higher-quality RCTs are required to confirm these conclusions.

OBJECTIVE: This meta-analysis is to evaluate the clinical efficacy of gamma knife radiosurgery (GKRS) for treating cavernous malformations.
METHODS: PubMed, Ovid Embase, and Ovid Medline electronic databases were searched. The primary outcome is hemorrhage rate and this meta-analysis is performed.
RESULTS: Nine studies are included in this meta-analysis. The overall risk ratio (RR) of hemorrhage rate of pre-GKRS and post-GKRS is 6.08 (95% confidence interval [CI], 5.04-7.35). The overall RR is 3.03 (95% CI, 2.65-4.11) between the hemorrhage rate of pre-GKRS and the first 2 years postradiosurgery, and the overall RR is 12.13 (95% CI, 1.73-85.07) comparing pre-GKRS with 2 years after GKRS. There is no significant difference of the hemorrhage rate between the first 2 years postradiosurgery and 2 years after GKRS (RR = 2.81; 95% CI, 0.20-13.42). The neurologic deficiency is the most common radiosurgery-related complication.
CONCLUSIONS: Patients with cerebral cavernous malformations, especially ones that were deep seated and surgically inaccessible, seem to benefit from GKRS owing to a reduction of annual hemorrhage rate in the first 2 years and 2 years after, despite several cases that suffer from negative side effects of radiation.

Surgical management is recommended for unstable distal clavicle fractures. A variety of methods have been previously reported, but there is no current consensus regarding which method is most suitable. Therefore, we have conducted a systematic review and network meta-analysis to compare postoperative shoulder function and complications between different fixation methods to identify which class of fixation is best for unstable distal clavicle fractures. We searched the literature systematically using eligibility criteria of all comparative studies that compared postoperative outcomes of coracoclavicular fixation (tight rope, screw or endobutton), hook plating, plate and screws, tension band wiring and transacromial pinning fixation for unstable distal clavicle fractures from PubMed, EMBASE, and Scopus databases up to February 10, 2018. Two reviewers independently extracted data. A network meta-analysis was applied to combine direct and indirect evidence and to estimate the relative effects of the treatment options. The probability of being the best treatment was estimated using surface under the cumulative ranking curves (SUCRA). Ten comparative studies (n = 505 patients) with one RCT study (n = 42) met the inclusion criteria. Intervention included coracoclavicular fixation (n = 111 patients), hook plating (n = 300 patients), plate and screws (n = 41 patients), tension band wiring (n = 81 patients) and transacromial pinning (n = 14 patients). A network meta-analysis showed that CM scores of coracoclavicular fixation were significantly higher when compared to hook plate and tension band wiring, with pooled mean of 2.98 (95% CI 0.05-5.91) and 7.11 (95% CI 3.04-11.18). For UCLA, CC fixation and plate and screw fixation had significantly higher scores compared to hook plating fixation with a mean score 2.22 (95% CI 0.44-3.99) and 3.20 (95% CI 0.28-6.12), respectively. In terms of complications, plate and screw fixation had lower risk with RRs of 0.63 (95% CI 0.20-1.98), 0.37 (95% CI 0.19-0.72), 0.11 (95% CI 0.04-0.30) and 0.02 (95% CI 0.002-0.16) when compared to coracoclavicular fixation, hook plating, tension band wiring and transacromial pinning. The SUCRA probabilities of CC fixation were in the first rank with 96.8% for CMS, while plate and screw fixation were in the first rank with 67.7 and 93.8% for UCLA score and complications. We recommend using plate and screw and CC fixation as the first- and second-line treatment of unstable distal clavicle fractures. As the quality of studies for this meta-analysis was not high, larger and higher-quality randomized controlled trials are required to confirm these conclusions for informed clinical decision making.

Cardiomyopathy syndrome (CMS) is a severe cardiac disease affecting Atlantic salmon Salmo salar L. The disease was first recognized in farmed Atlantic salmon in Norway in 1985 and subsequently in farmed salmon in the Faroe Islands, Scotland and Ireland. CMS has also been described in wild Atlantic salmon in Norway. The demonstration of CMS as a transmissible disease in 2009, and the subsequent detection and initial characterization of piscine myocarditis virus (PMCV) in 2010 and 2011 were significant discoveries that gave new impetus to the CMS research. In Norway, CMS usually causes mortality in large salmon in ongrowing and broodfish farms, resulting in reduced fish welfare, significant management-related challenges and substantial economic losses. The disease thus has a significant impact on the Atlantic salmon farming industry. There is a need to gain further basic knowledge about the virus, the disease and its epidemiology, but also applied knowledge from the industry to enable the generation and implementation of effective prevention and control measures. This review summarizes the currently available, scientific information on CMS and PMCV with special focus on epidemiology and factors influencing the development of CMS.

OBJECTIVE: To evaluate the effectiveness of shock wave therapy (SWT) for functional improvement and the reduction of pain in patients with calcific tendinitis of the shoulder, and to determine the rate of disappearance of calcifications after therapy at 6 months\' follow-up.
METHODS: Articles were searched from the Cochrane Library, MEDLINE, Embase, CINAHL, and Ovid database.
METHODS: We included randomized controlled trials from 1992 to 2011, and their quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.
METHODS: Studies were evaluated by 2 independent reviewers for their methodologic quality. Disagreements were settled by a third reviewer. Data were then extracted and cross-checked for accuracy. The reviewers were not blinded to the authors of the articles.
RESULTS: In 4 of the 6 studies included for review, the resorption of calcifications was evaluated using meta-analysis because the studies had 2 treatment groups, while the other 2 studies were analyzed descriptively because they had 3 treatment groups. Fixed- and random-effects models were used to meta-analyze total and partial resorption ratios, and I(2) statistics were calculated to assess heterogeneity.
CONCLUSIONS: We found a clinical improvement with a pooled total resorption ratio of 27.19 (95% confidence interval [CI], 7.20-102.67) and a pooled partial resorption ratio of 16.22 (95% CI, 3.33-79.01). SWT increases shoulder function, reduces pain, and is effective in dissolving calcifications. These results were maintained over the following 6 months.