Potential for health care cost savings with preoperative gastrostomy tube placement in the head and neck cancer population

Abstract

Background

The purpose of this study was to examine the cost differences between preoperative and postoperative placement of gastrostomy tubes (G-tubes) in patients with head and neck cancer.

Methods

We conducted a retrospective chart review of patients with aerodigestive tract cancers from 2010 to 2015. Data included inpatient and postdischarge costs, demographics, tumor characteristics, surgical treatment, length of stay (LOS), time spent in the intensive care unit (ICU), and readmissions.

Results

Five hundred ninety patients were included in this study. There was a $7624 inpatient cost savings (P = .002) for those G-tubes placed preoperatively ($26 060) versus postoperatively ($33 754). Postdischarge costs did not differ significantly between groups (P = .60). There was a $9248 total costs savings (P = .009) for those patients with G-tubes placed preoperatively ($39 751) versus postoperatively ($48 999), despite patients with preoperative G-tubes having lower body mass index (BMI; P = .009), higher Association of Anesthesiologist (ASA) class (P = .02), more preoperative radiation (P < .001), and more free tissue transfer reconstruction (P = .007).

Conclusion

There is potential for savings by placing G-tubes preoperatively, possibly driven by decreased LOS, despite data suggesting that patients with G-tubes placed preoperatively are higher risk.

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Usability of advanced pneumatic compression to treat cancer-related head and neck lymphedema: A feasibility study

Abstract

Background

This functional usability study assessed ease of use, fit, comfort, and potential clinical benefits of advanced pneumatic compression treatment of cancer-related head and neck lymphedema.

Methods

Patient-reported comfort and other treatment aspects were evaluated and multiple face and neck measurements were obtained on 44 patients with head and neck lymphedema before and after 1 treatment session to assess usability and treatment-related lymphedema changes.

Results

A majority of the patients (82%) reported the treatment was comfortable; most patients (61%) reported feeling better after treatment, and 93% reported that they would be likely to use this therapy at home. One treatment produced overall small but highly statistically significant reductions in composite metrics (mean ± SD) of the face (82.5 ± 4.3 cm vs 80.9 ± 4.1 cm; P < .001) and neck (120.4 ± 12.2 cm vs 119.2 ± 12.1 cm; P < .001) with no adverse events.

Conclusion

Results found the treatment to be safe, easy to use, and well tolerated while demonstrating edema reduction after a single initial treatment.

http://ift.tt/2jmxxHW

Asthma versus chronic obstructive pulmonary disease, the Dutch versus British hypothesis, and role of interleukin-5

Purpose of review Asthma and COPD represent heterogeneous disorders with broad ranging impact on patients and health systems. This review focuses on evidence for early attempts at understanding their pathogenesis by the British and Dutch hypotheses. It also addresses the role of eosinophils, IL-5, and biologics targeting these pathways in asthma and COPD. Recent findings Among asthma and COPD patients, clusters exist based on phenotypic and biologic markers allowing for further understanding of endotypes. Recent studies suggest the role of eosinophils and optimal therapies for each condition may be different. Summary Although patients with ACOS or overlap symptoms may be an exception, overall there appears to be more evidence supporting that asthma and COPD are distinct processes. Targeting eosinophils with anti-IL-5 therapy appears to be an exciting pathway in the properly selected patient with asthma and recent data also supports its use in COPD. Correspondence to Sanjiv Sur, Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA. E-mail: Sasur@utmb.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jmw9W2

Update on questionnaires for assessing adherence to inhaler devices in respiratory patients

Purpose of review It has been estimated that adherence to inhaled medications in patients with asthma and chronic obstructive pulmonary disease (COPD) is around 50%. This low adherence rate increases morbidity and mortality of these disorders. The objective of this review was to update information on main questionnaires used in daily for assessing adherence to inhalers of patients with chronic respiratory diseases. Recent findings The test of the adherence to inhalers (TAI) is a recently developed and validated 12-item questionnaire to assess adherence to inhalers of aerosolized drugs in patients with asthma or COPD. The instrument can easily identify nonadherence, classify the level of adherence into good, intermediate and poor, and establish three nonadherence behaviour patterns of erratic, deliberate, and unwitting, which are useful for tailoring corrective measures. Summary Adherence to inhaler devices may be underestimated with the use of validated self-report questionnaires as compared with other more sensitive methods. However, validated self-report questionnaires are more advantageous from a cost-effective perspective in clinical practice. The recently validated TAI is a reliable and homogeneous instrument to identify easily nonadherence and behavioural barriers to the use of inhalers in patients with asthma or COPD. Correspondence to Dr Vicente Plaza, MD, PhD, Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni M. Claret 167, E-08025 Barcelona, Spain. Tel: +34 93 5565972; fax: +34 93 5565601; e-mail: vplaza@santpau.cat Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2htTPHr

Drug-induced anaphylaxis: is it an epidemic?

Purpose of review The present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis. Recent findings Anaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis. Summary Drug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated. Correspondence to Pedro Giavina-Bianchi, MD, PhD, Clinical Immunology and Allergy Division, University of São Paulo, R. Prof. Artur Ramos 178 ap.211A, Jd. América, São Paulo CEP:01454-904, SP, Brazil. Tel: +55 11 30713189; fax: +55 11 30713189; e-mail: pbianchi@usp.br Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jnMxFz

Extent and consequences of inadequate disease control among adults with a history of moderate to severe atopic dermatitis

Abstract

Since control of atopic dermatitis (AD) remains challenging but has not been adequately characterized, the objective of this study was to characterize disease control among patients with a history of moderate to severe AD. Data were from the 2014 Adelphi US AD Disease Specific Programme, a cross-sectional survey of physicians (n = 202) and their patients with history of moderate to severe AD (n = 1064, 54% female, 75% white, mean age 40 years). Inadequately controlled AD as rated by the physician was defined as currently flaring; deteriorating/changeable AD; or physician dissatisfaction with current control. The overall inadequate control rate was 58.7% (n = 625), which increased with current AD severity and was observed in 53.4% and 83.4% of patients receiving immunosuppressants and systemic corticosteroids, respectively. Relative to controls, inadequately controlled patients had poorer disease-specific quality of life, higher level of work impairment, greater itch and sleep interference with daily living (all P < 0.05). Multivariate analysis showed factors significantly associated with inadequate control (all P < 0.05), including Hispanic race, symptoms on the head/neck or lower limbs, itch and sleep interference with daily living. A limitation of the study was reliance on accuracy of reporting, potential selection bias and cross-sectional study design. In summary, there was a high rate and substantial impact of physician-rated inadequately controlled disease among patients with a history of moderate to severe AD, suggesting the need for more effective therapies.

http://ift.tt/2AFQ1Yq

Utility of Gram staining for diagnosis of Malassezia folliculitis

Abstract

Malassezia folliculitis (MalF) mimics acne vulgaris and bacterial folliculitis in clinical presentations. The role of Gram staining in rapid diagnosis of MalF has not been well studied. In our study, 32 patients were included to investigate the utility of Gram staining for MalF diagnosis. The final diagnoses of MalF were determined according to clinical presentation, pathological result and treatment response to antifungal agents. Our results show that the sensitivity and specificity of Gram staining are 84.6% and 100%, respectively. In conclusion, Gram staining is a rapid, non-invasive, sensitive and specific method for MalF diagnosis.

http://ift.tt/2yvCTU5

Keratosis follicularis squamosa (Dohi) successfully treated with benzoyl peroxide 2.5% gel

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Laparoscopic repair of a right diaphragmatic hernia in a post-partum lady

Abstract

Traumatic diaphragmatic injuries (TDI) are often challenging to diagnose. Research suggests that no single diagnostic study is sensitive or specific enough to identify such an injury, unless there is established herniation of intrabdominal contents. It is a rare cause of small bowel obstruction, which carries a substantial mortality rate. This report describes a case of a 41-year-old pregnant female who presented with irretractable vomiting and abdominal pain secondary to a delayed presentation of right-sided TDI. The most accepted mechanism regarding TDI is due to sudden elevation in the pleuroperitoneal pressure gradient. This case is unusual given its mechanism of injury during pregnancy and its right-sided location. She underwent laparoscopy which facilitated successful reduction of the hernial and closure of the defect. Postoperatively, she made an excellent recovery and was discharged within a few days. This report aims to increase the awareness amongst surgeons.

http://ift.tt/2hp7Tyh

Issue Information - TOC

http://ift.tt/2ywkzdq

Teaching & Learning Tips 2: Cognitive load theory

Abstract

Challenge: Dermatology trainees include medical students, residents, and fellows. Variability in level of experience and background knowledge can make clinical teaching challenging. Research also shows novices have different ways of thinking than experts, which must be acknowledged in the preceptor-trainee interaction for optimal teaching and learning to occur. Herein we explore how "cognitive load" varies with learner level and how reducing cognitive load can enhance learning, especially for novice learners.

http://ift.tt/2ADQla5

Sequence variants in nine different genes underlying rare skin disorders in 10 consanguineous families

Abstract

Background

Genodermatoses represent genetic anomalies of skin tissues including hair follicles, sebaceous glands, eccrine glands, nails, and teeth. Ten consanguineous families segregating various genodermatosis phenotypes were investigated in the present study.

Methods

Homozygosity mapping, exome, and Sanger sequencing were employed to search for the disease-causing variants in the 10 families.

Results

Exome sequencing identified seven homozygous sequence variants in different families, including: c.27delT in FERMT1; c.836delA in ABHD5; c.2453C>T in ERCC5; c.5314C>T in COL7A1; c.1630C>T in ALOXE3; c.502C>T in PPOX; and c.10G>T in ALDH3A2. Sanger sequencing revealed three homozygous variants: c.1718 + 2A>G in FERMT1; c.10459A>T in FLG; and c.92delT in the KRT14 genes as the underlying genetic cause of skin phenotypes.

Conclusion

This study supports the use of exome sequencing as a powerful, efficient tool for identifying genes that underlie rare monogenic skin disorders.

http://ift.tt/2yy6Anz

Evaluation of the serum zinc level in adult patients with melasma: Is there a relationship with serum zinc deficiency and melasma?

Summary

Background

Melasma is a common acquired hypermelanosis of sun-exposed skin, particularly on the face, which presents as symmetric, light- to gray-brown-colored macules and patches. There are several studies of serum zinc levels in cutaneous disorders. So far, no studies have been carried out to assess the serum zinc level in patients with melasma. The aim of this study is to determine the serum zinc level in patients with melasma compared to healthy subjects.

Materials and methods

A total of 118 patients with melasma and 118 healthy controls were enrolled in this prospective cross-sectional study. The two groups were matched for age and sex. Atomic absorption spectrophotometry was used to measure serum zinc levels. The statistical analysis was performed using SPSS software.

Results

The mean serum level of zinc in melasma patients and controls was 77.4±23.2 μg/dL and 82.2±23.9 μg/dL, respectively (P-value=.0001). Serum zinc deficiency was found in 45.8% and 23.7% of melasma patients and control subjects, respectively. A positive family history of melasma in first-degree relatives was present in 46 (39%) of the cases, and a history of taking oral contraceptive pill was found in 95 (81%) of women with melasma. The aggravating factors for melasma were stated as: sun exposure (11.1%), pregnancy (15.3%), nutrition (2.5%), oral contraceptive pills (18.6%), and emotional stress (5.9%). The malar and centrofacial patterns were seen in 3.4% and 72% of cases, respectively, whereas 24.6% of the patients had both centrofacial distribution and malar distribution, and there was no patient with mandibular pattern. Among patients with melasma, 20.3% had thyroid dysfunction, while in the control subjects, 8.4% had thyroid dysfunction (P=.001).

Conclusion

There is a significant relationship between low levels of zinc and melasma. Zinc deficiency may be involved in the pathogenesis of melasma. Also, treatment with oral zinc supplements can be tried in these patients to see the outcome. However, to make recommendations on screening for zinc deficiency in patients with melasma, future research of good methodological quality is needed.

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Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial

BACKGROUND Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN A randomised, observer-blinded, equivalence trial (equivalence margin = 7.4 min). SETTING Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017. PATIENTS A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 μg ml−1 and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). RESULTS Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, −4.8; 95% confidence interval, −8.1 to −1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events. CONCLUSION Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min). TRIAL REGISTRATION www.clinicaltrials in the (Study ID: TCTR20160427003). Correspondence to De Q. Tran, MD, FRCPC, Professor, Department of Anaesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, Montreal, QC, Canada H3G-1A4 Tel: +1 514 934 1934x43261; fax: +1 514 934 8249; e-mail: de_tran@hotmail.com © 2017 European Society of Anaesthesiology

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Ischemia reperfusion injury in aged livers - the energy metabolism, inflammatory response and autophagy

Abstract Due to the lack of adequate organs, the number of patients with end-stage liver diseases, acute liver failure or hepatic malignancies waiting for liver transplantation is constantly increasing. Accepting aged liver grafts is one of the strategies expanding the donor pool to ease the discrepancy between the growing demand and the limited supply of donor organs. However, recipients of organs from old donors may show an increased post-transplantation morbidity and mortality due to enhanced ischemia reperfusion injury. Energy metabolism, inflammatory response and autophagy are three critical processes which are involved in the ageing progress as well as in hepatic ischemia reperfusion injury. Compared to young liver grafts, impairment of energy metabolism in aged liver grafts leads to lower ATP production and an enhanced generation of free radicals, both aggravating the inflammatory response. The aggravated inflammatory response determines the extent of hepatic ischemia reperfusion injury and augments the liver damage. Autophagy protects cells by removal of damaged organelles including dysfunctional mitochondria, a process impaired in ageing and involved in ischemia reperfusion related apoptotic cell death. Furthermore, autophagic degradation of cellular compounds relieves intracellular ATP level for the energy depressed cells. Strategies targeting the mechanisms involved in energy metabolism, inflammatory response and autophagy might be especially useful to prevent the increased risk for ischemia reperfusion injury in aged livers after major hepatic surgery. CORRESPONDING AUTHOR: Uta Dahmen, M.D., Experimental Transplantation Surgery, Department of General, Visceral, and Vascular Surgery, Friedrich Schiller University of Jena, Drackendorfer Straße 1, 07747 Jena, Germany. Telephone: +49-03641-932 5350; FAX: +49-03641-932 5352; E-mail: Uta.Dahmen@med.uni-jena.de AUTHORSHIP Kan C. (Chunyi.Kan@med.uni-jena.de) contributed to conception and design as well as participated in writing the article; Ungelenk L. (Luisa.Ungelenk@med.uni-jena.de) participated in the critical revision of the article; Lupp A. (Amelie.Lupp@med.uni-jena.de) participated in the critical revision of the article; Dirsch O. (Olaf.Dirsch@gmail.com) contributed to conception, design and obtain funding as well as participated in the critical revision of the article. Dahmen U. (Uta.Dahmen@med.uni-jena.de) contributed to conception, design and obtain funding as well as participated in the critical revision of the article. DISCLOSURE The authors disclose no conflicts of interest. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2huP5Bi

Asthma versus chronic obstructive pulmonary disease, the Dutch versus British hypothesis, and role of interleukin-5

Purpose of review Asthma and COPD represent heterogeneous disorders with broad ranging impact on patients and health systems. This review focuses on evidence for early attempts at understanding their pathogenesis by the British and Dutch hypotheses. It also addresses the role of eosinophils, IL-5, and biologics targeting these pathways in asthma and COPD. Recent findings Among asthma and COPD patients, clusters exist based on phenotypic and biologic markers allowing for further understanding of endotypes. Recent studies suggest the role of eosinophils and optimal therapies for each condition may be different. Summary Although patients with ACOS or overlap symptoms may be an exception, overall there appears to be more evidence supporting that asthma and COPD are distinct processes. Targeting eosinophils with anti-IL-5 therapy appears to be an exciting pathway in the properly selected patient with asthma and recent data also supports its use in COPD. Correspondence to Sanjiv Sur, Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA. E-mail: Sasur@utmb.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jmw9W2

Update on questionnaires for assessing adherence to inhaler devices in respiratory patients

Purpose of review It has been estimated that adherence to inhaled medications in patients with asthma and chronic obstructive pulmonary disease (COPD) is around 50%. This low adherence rate increases morbidity and mortality of these disorders. The objective of this review was to update information on main questionnaires used in daily for assessing adherence to inhalers of patients with chronic respiratory diseases. Recent findings The test of the adherence to inhalers (TAI) is a recently developed and validated 12-item questionnaire to assess adherence to inhalers of aerosolized drugs in patients with asthma or COPD. The instrument can easily identify nonadherence, classify the level of adherence into good, intermediate and poor, and establish three nonadherence behaviour patterns of erratic, deliberate, and unwitting, which are useful for tailoring corrective measures. Summary Adherence to inhaler devices may be underestimated with the use of validated self-report questionnaires as compared with other more sensitive methods. However, validated self-report questionnaires are more advantageous from a cost-effective perspective in clinical practice. The recently validated TAI is a reliable and homogeneous instrument to identify easily nonadherence and behavioural barriers to the use of inhalers in patients with asthma or COPD. Correspondence to Dr Vicente Plaza, MD, PhD, Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni M. Claret 167, E-08025 Barcelona, Spain. Tel: +34 93 5565972; fax: +34 93 5565601; e-mail: vplaza@santpau.cat Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2htTPHr

Drug-induced anaphylaxis: is it an epidemic?

Purpose of review The present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis. Recent findings Anaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis. Summary Drug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated. Correspondence to Pedro Giavina-Bianchi, MD, PhD, Clinical Immunology and Allergy Division, University of São Paulo, R. Prof. Artur Ramos 178 ap.211A, Jd. América, São Paulo CEP:01454-904, SP, Brazil. Tel: +55 11 30713189; fax: +55 11 30713189; e-mail: pbianchi@usp.br Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jnMxFz

Diabetes mellitus in a patient with glycogen storage disease type Ia: a case report

Glycogen storage disease type Ia is a genetic disorder that is associated with persistent fasting hypoglycemia and the inability to produce endogenous glucose. The development of diabetes with glycogen storage...

http://ift.tt/2hsBmuN

Cancer stem cell and its niche in malignant progression of oral potentially malignant disorders

Publication date: December 2017
Source:Oral Oncology, Volume 75
Author(s): Subin Surendran, Gangotri Siddappa, Amrutha Mohan, Wesley Hicks, Vijayvel Jayaprakash, Christina Mimikos, Mohammed Mahri, Fatima Almarzouki, Kayla Morrell, Ravindra Ravi, Sindhu Govindan, C.N. Sushma, Nisheena Raghavan, Praveen Birur, Jeyaram Ilayaraja, Mihai Merzianu, Mary Reid, Amritha Suresh, Moni Abraham Kuriakose
ObjectiveThe purpose of this study was to determine association between cancer stem cells (CSCs) and their niche with progression of oral potentially malignant disorders.Materials and methodsPatients with histologically confirmed oral potentially malignant disorders, stratified into high/low risk lesions based on the degree of dysplasia and oral cancer were included in this study. Immunohistochemical profiling of markers of CSCs (CD44), endothelial cells (CD31) and CSC-vascular niche cross-talk (CXCR4 and SDF1) were carried out. Statistical analysis was performed to correlate the relationship of markers with histopathology grade (ANOVA, and χ² test, unpaired t test) using GraphPad InStat v3.06.ResultsThe study included 550 samples (349 patients) and analysis showed progressive increase in expression levels of CSC and its niche markers with increase in grade of dysplasia as compared to the normal cohort (p < 0.05). Co-expression analysis revealed that, in comparison to the normal cohort, a larger percentage of patients showed increased expression of CD31 and CD44 (CD31^high/CD44^high; p < 0.05) and of CXCR4 and SDF1 (CXCR4^high/SDF1^high; p = 0.04), suggesting an association of the CSCs and the vascular niche. Further, distribution of patients with CD44^high/CXCR4^high (p < 0.05) and CD31^high/SDF1^high (p = 0.01) was significantly increased in the high-risk group (18%), suggesting a correlation between CD44⁺/CXCR4⁺ cells, the vascular niche and progression of oral dysplastic lesions.ConclusionThe increased expression of CSCs, the vascular niche and their cross talk markers are associated with increase in severity of dysplasia suggesting their role in the progression of oral potentially malignant disorders and may hence be used in identifying high-risk OPMD.



http://ift.tt/2hnOyx8

Evaluating the association between household air pollution and oral cancer

Publication date: Available online 12 November 2017
Source:Oral Oncology
Author(s): A. Thirumal Raj, Shankargouda Patil, Sachin C. Sarode, Gargi S. Sarode, Chandini Rajkumar




http://ift.tt/2hnOwW2

CRP is linked to disease activity, impact and response to treatment in patients with chronic spontaneous urticaria

Abstract

Background

Elevated levels of C-reactive protein (CRP), a sensitive marker of inflammation, have been consistently reported in chronic spontaneous urticaria. Here, we retrospectively analyzed data from 1,253 CSU patients from two centers to answer the following questions: 1) What is the prevalence of elevated levels of CRP in CSU? 2) Why do CSU patients show elevated levels of CRP? 3) Are elevated CRP levels relevant?

Methods

Serum levels of CRP were measured by the nephelometric method. We collected information regarding various laboratory tests including ESR, CBC with differential, D-dimer, fibrinogen, C3, C4, IL-6 etc. For most patients, we also collected data on age, gender, duration of CSU, presence of angioedema, activity (UAS at the time of blood sampling and for 7 days), quality of life (CU-Q2oL and/or DLQI), comorbidities and possible causes of CSU, and autologous serum skin test (ASST) response. The efficacy of second generation antihistamines was evaluated at the day of blood collecting.

Results

One third of CSU patients had elevated levels of CRP. Higher levels of CRP were associated with ASST positivity (p=0.009) and arterial hypertension (p=0.005), but not with other possible causes or comorbidities of CSU. CRP correlated with urticaria activity (p<0.001), quality of life impairment (p=0.026), inflammatory and coagulation markers (p<0.001). CRP levels were significantly higher in non-responders to antihistamines as compared to responders (p<0.001).

Conclusion

Elevated levels of CRP are common and relevant in CSU patients. The assessment of CRP levels may help to optimize the management of patients with CSU.

This article is protected by copyright. All rights reserved.

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Algorithmic Decision-Making Based on Machine Learning from Big Data: Can Transparency Restore Accountability?

Abstract

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves ("gaming the system" in particular), the potential loss of companies' competitive edge, and the limited gains in answerability to be expected since sophisticated algorithms usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante.

http://ift.tt/2AAzfJb