No abstract availablehttp://ift.tt/2o4NMsD
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 16 Φεβρουαρίου 2018
Post-Cardiac Arrest Management: Time to Cool It on Cooling?
No abstract availablehttp://ift.tt/2o4NMsD
Targeted Temperature Management After Cardiac Arrest: Systematic Review and Meta-analyses
BACKGROUND: Targeted temperature management (TTM) with therapeutic hypothermia is an integral component of postarrest care for survivors. However, recent randomized controlled trials (RCTs) have failed to demonstrate the benefit of TTM on clinical outcomes. We sought to determine if the pooled data from available RCTs support the use of prehospital and/or in-hospital TTM after cardiac arrest. METHODS: A comprehensive search of SCOPUS, Elsevier's abstract and citation database of peer-reviewed literature, from 1966 to November 2016 was performed using predefined criteria. Therapeutic hypothermia was defined as any strategy that aimed to cool post–cardiac arrest survivors to a temperature ≤34°C. Normothermia was temperature of ≥36°C. We compared mortality and neurologic outcomes in patients by categorizing the studies into 2 groups: (1) hypothermia versus normothermia and (2) prehospital hypothermia versus in-hospital hypothermia using standard meta-analytic methods. A random effects modeling was utilized to estimate comparative risk ratios (RR) and 95% confidence intervals (CIs). RESULTS: The hypothermia and normothermia strategies were compared in 5 RCTs with 1389 patients, whereas prehospital hypothermia and in-hospital hypothermia were compared in 6 RCTs with 3393 patients. We observed no difference in mortality (RR, 0.88; 95% CI, 0.73–1.05) or neurologic outcomes (RR, 1.26; 95% CI, 0.92–1.72) between the hypothermia and normothermia strategies. Similarly, no difference was observed in mortality (RR, 1.00; 95% CI, 0.97–1.03) or neurologic outcome (RR, 0.96; 95% CI, 0.85–1.08) between the prehospital hypothermia versus in-hospital hypothermia strategies. CONCLUSIONS: Our results suggest that TTM with therapeutic hypothermia may not improve mortality or neurologic outcomes in postarrest survivors. Using therapeutic hypothermia as a standard of care strategy of postarrest care in survivors may need to be reevaluated.http://ift.tt/2o2mXpi
Perioperative Cardiac Arrest: Focus on Malignant Hyperthermia (MH)
No abstract availablehttp://ift.tt/2odiwXN
Perioperative Cardiac Arrest: Focus on Local Anesthetic Systemic Toxicity (LAST)
No abstract availablehttp://ift.tt/2o5nN4D
Cardiac Arrest in the Operating Room: Part 2—Special Situations in the Perioperative Period
As noted in part 1 of this series, periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA. There is a growing body of literature describing the incidence, causes, treatment, and outcomes of common causes of PPCA (eg, malignant hyperthermia, massive trauma, and local anesthetic systemic toxicity) and the need for a better awareness of these topics within the anesthesiology community at large. As noted in part 1 of this series, these events are always witnessed by a member of the perioperative team, frequently anticipated, and involve rescuer–providers with knowledge of the patient and the procedure they are undergoing or have had. Formulation of an appropriate differential diagnosis and rapid application of targeted interventions are critical for good patient outcome. Resuscitation algorithms that include the evaluation and management of common causes leading to cardiac in the perioperative setting are presented. Practicing anesthesiologists need a working knowledge of these algorithms to maximize good outcomes.http://ift.tt/2o5nRBp
Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist Part 1
Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure. In this setting, there can be formulation of a differential diagnosis and a directed intervention that treats the likely underlying cause(s) of the crisis while concurrently managing the crisis itself. Management of cardiac arrest of the perioperative patient is predicated on expert opinion, physiologic rationale, and an understanding of the context in which these events occur. Resuscitation algorithms should consider the evaluation and management of these causes of crisis in the perioperative setting.http://ift.tt/2ocrCEj
Syndromic sebaceous nevus: current findings
Abstract
Background
Sebaceous nevus is a congenital malformation of the skin that usually occurs on the scalp or face. Syndromic forms do rarely exist with associated cerebral and ocular malformations. The skin lesions are pale at birth and become irregular by puberty. In the adult patient, tumors (usually benign) develop from sebaceous nevus. Their surgical excision during childhood can give a better result in terms of the definitive scar.
Objectives
The aim of this study is to analyze our cases of syndromic sebaceous hamartoma, perform a review of the existing literature, and propose guidelines for the therapeutic plan.
Methods
This is a retrospective study reviewing the cases of syndromic sebaceous nevus treated in the Department of Orthopedic Plastic Pediatric Surgery in Montpellier, France, and the Department of Pediatric Surgery in Lausanne, Switzerland, between 1994 and 2016.
Results
The files of six patients with syndromic sebaceous nevus were analyzed. The average age at the first consultation was 4 months. The location was craniofacial in all cases. Cerebral radiological imaging was performed on all patients; two showed abnormal findings. Four patients underwent ophthalmic examination, which all revealed abnormalities. Three patients had other associated malformations. Three patients presented with epilepsy or learning difficulties in the course of follow-up.
Conclusion
All patients presenting with extensive sebaceous nevus of the craniofacial region should benefit from cerebral imagery and ophthalmic examination since there is a very high probability of associated abnormalities. The developmental problems encountered could not be definitively associated with the skin malformations.
http://ift.tt/2Bz7XGO
Cholesterol Esterification Enzyme Inhibition Enhances Antitumor Effects of Human Chimeric Antigen Receptors Modified T Cells
Chimeric antigen receptor-modified T cell (CART) therapy has been demonstrated to have significant effect on hematologic tumor in patients. However, many persistent obstacles and challenges still limit the application. It is known that CD8+ T cells are a key component of antitumor immunity. An avasimibe-induced inhibition of cholesterol esterification has been shown to improve the antitumor response of CD8+ T cells in mice. In this study, using human CD19-directed CART cells as effector cells and CD19-overexpressing K562 cells as target cells, we detected whether cholesterol acyltransferase inhibition by avasimibe can enhance the antitumor effect of human CART cells. After avasimibe treatment, the infection rate was dropped by up to 50% (Phttp://ift.tt/2Byq7bK
Eomesodermin Increases Survival and IL-2 Responsiveness of Tumor-specific CD8+ T Cells in an Adoptive Transfer Model of Cancer Immunotherapy
Tumor-specific CD8+ T cells often fail to elicit effective antitumor immune responses due to an inability to expand into a substantial effector population and persist long-term in vivo. Using an adoptive transfer model of cancer immunotherapy, we demonstrate that constitutive eomesodermin (Eomes) expression in tumor-specific CD8+ T cells improves tumor rejection and survival. The increase in tumor rejection was associated with an increased number and persistence of CD8+ T cells in lymphoid tissues during acute tumor rejection, tumor regrowth, and in mice that remained tumor-free. Constitutive Eomes expression increased expression of CD25, and this was associated with enhanced interleukin-2 responsiveness and tumor-specific CD8+ T-cell proliferation. Moreover, constitutive Eomes expression improved cell survival. Taken together, our data suggest that constitutive Eomes expression enhances CD8+ T-cell proliferation and survival, in part through the enhancement of interleukin-2 responsiveness through CD25 induction.http://ift.tt/2C3EHsQ
Pembrolizumab Utilization and Outcomes for Advanced Melanoma in US Community Oncology Practices
The programmed death-1 inhibitor pembrolizumab has demonstrated efficacy and safety in clinical trials for treating advanced (unresectable/metastatic) melanoma. We investigated the real-world utilization of pembrolizumab and associated patient outcomes for advanced melanoma in US community oncology practices. This retrospective, observational study used deidentified data from electronic health records for adult patients with advanced melanoma who received pembrolizumab at The US Oncology Network sites from September 2014 through December 2015, with follow-up through September 2016. Patients enrolled in clinical trials were excluded. Overall survival (OS) and physician-stated progression-free survival (PFS) were analyzed from pembrolizumab initiation using Kaplan-Meier, and associations between pembrolizumab therapy and OS/PFS, using multivariable Cox regression. Of 168 patients studied, 110 (65%) were male; the median age was 66 years (range, 26–over 90). Pembrolizumab was prescribed as first-line, second-line, and third-line/later for 39 (23%), 87 (52%), and 42 (25%) patients, respectively. In total, 41 patients (24%) had brain metastases. At pembrolizumab initiation, 21/129 (16%) had Eastern Cooperative Oncology Group performance status (ECOG PS) >1; 51/116 (44%) had elevated lactate dehydrogenase. Median follow-up was 10.5 months (range, 0–25.1); median OS was 19.4 months (95% confidence interval, 14.0–not reached); median PFS was 4.2 months (95% confidence interval, 2.9–5.3). Brain metastases, ECOG PS>1, elevated lactate dehydrogenase, and third-line/later (vs. first-line) pembrolizumab were significant predictors (Phttp://ift.tt/2Byq5AE
Ex Vivo-expanded Natural Killer Cells Derived From Long-term Cryopreserved Cord Blood are Cytotoxic Against Primary Breast Cancer Cells
With over 600,000 units of umbilical cord blood (CB) stored on a global scale, it is important to elucidate the therapeutic abilities of this cryopreserved reservoir. In the advancing field of natural killer (NK) cell cancer immunotherapy, CB has proven to be a promising and noninvasive source of therapeutic NK cells. Although studies have proven the clinical efficacy of using long-term cryopreserved CB in the context of hematopoietic stem cell transplantations, little is known about its use for the ex vivo expansion of effector immune cells. Therefore, our group sought to derive ex vivo-expanded NK cells from long-term cryopreserved CB, using an artificial antigen presenting cell–mediated expansion technique. We compared the expansion potential and antitumor effector function of CB-derived NK (CB-NK) cells expanded from fresh (n=4), short-term cryopreserved (http://ift.tt/2C4gi6E
Significance of Immune-related Lipase Increase Induced by Antiprogrammed Death-1 or Death Ligand-1 Antibodies: A Brief Communication
Antiprogrammed death-1 (anti-PD1) and antiprogrammed death ligand-1 (anti-PD-L1) antibodies are effective checkpoint inhibitors that stimulate the immune system against many types of cancers. The flip side of these immunotherapies is the generation of immune-related adverse events, which can theoretically affect all organs. Among these side effects, lipase increase is frequently observed; however the meaning of this biological abnormality remains poorly understood. We investigate in this case study all the lipase increases greater or equal to grade 2 that occurred in patients receiving anti-PD-1 or anti-PD-L1 treatments, to determine their biological and clinical significance. Twenty-one patients were retained with lipase increase related to the immune checkpoint inhibitor. Most of them (71%) were treated for a metastatic melanoma. The peak of lipase increase was observed at a median of 2.8 (range, 0.4–11.4) months after the initiation of the anti-PD1 or anti-PD-L1 treatment, which correlates with cycle 5 of treatment. Three of 21 patients (14%) had a clinical or radiologic immune-related pancreatitis that led to a permanent discontinuation of the treatment. In 15 of 21 (71%) patients, the lipase increase was not considered as clinically significant, and the treatment was continued without complications. The 3 remaining patients discontinued the treatment for progressive disease. These data indicate that lipase increase related to anti-PD1 or anti-PD-L1 is not associated with a significant clinical event in most cases. On the basis of these data, we propose that lipase increase in an asymptomatic patient and without radiographic abnormalities of the pancreas can be reasonably regarded as a not clinically significant event, allowing the continuation of the anti-PD-1 or anti-PD-L1 treatment.http://ift.tt/2BynRBk
CD19 Chimeric Antigen Receptor T Cells From Patients With Chronic Lymphocytic Leukemia Display an Elevated IFN-γ Production Profile
CD19 chimeric antigen receptor (CAR) T cell immunotherapy has demonstrated dramatic results for the treatment of B cell malignancies such as chronic lymphocytic leukemia (CLL). As T cell defects are common in patients with CLL, we compared the T cells from these patients with healthy donors (HDs), and subsequently the CD19 CAR T cells produced from patients and HDs. Despite initial differences when comparing the phenotype of circulating T cells in patients with CLL and HDs, the CD19 CAR T cells manufactured from patients' or HDs' cells showed a similar phenotype (effector memory or terminally differentiated), both were specifically activated by and killed CD19+ target cells, and secreted cytokines (ie, IL-2, TNF, and IFN-γ). The frequency of CD19 CAR T cells producing IFN-γ was significantly higher in cells produced from patients as compared with those produced from HDs. Furthermore, our data showed that the polyfunctional profile of CD19 CAR+ T cells was differently modulated by CD19+ K562 cells and autologous B cells. The increased IFN-γ production by CD19 CAR T cells produced from patients with CLL after in vitro stimulation, may if this is also the case in vivo, contribute to a higher risk of a cytokine release syndrome in patients. The different impact by CD19+ target cells on the polyfunctional profile of CD19 CAR T cells in vitro underlines the importance of the choice of CD19+ target cells when assessing CD19 CAR T cells functions.http://ift.tt/2C4geUs
Pneumonitis in Irradiated Lungs After Nivolumab: A Brief Communication and Review of the Literature
Nivolumab is a feasible therapy option in patients with advanced non–small cell lung cancer (NSCLC) who progress on first-line treatment. However, there is limited information about an overlapping toxicity of PD-1 inhibitors when administered following thoracic radiotherapy (TRT). Three of 25 patients with advanced NSCLC were treated with palliative or curative intent. Nivolumab was initiated as second or third-line therapy after TRT for recurrent or progressive disease. All 3 patients developed grade 3 pneumonitis at some point during nivolumab therapy. Herein, we describe 3 cases of pneumonitis in patients with NSCLC started on nivolumab following TRT. Imaging analysis was strongly consistent with heterogenous lung parenchyma changes in the irradiated lung volume receiving a total dose of 15–20 Gy. Pulmonary toxicity was manageable; however, interruption of immunotherapy was necessary.http://ift.tt/2ByNx0x
Clinical Characteristics of Subtypes of Follicular Variant Papillary Thyroid Carcinoma
Thyroid , Vol. 0, No. 0.
http://ift.tt/2o6Uaj9
Tertiary Care Experience of Sorafenib in the Treatment of Progressive Radioiodine-Refractory Differentiated Thyroid Carcinoma: A Korean Multicenter Study
Thyroid , Vol. 0, No. 0.
http://ift.tt/2oeZBM6
Perioperative Inflammation and Its Modulation by Anesthetics
Surgery and other invasive procedures, which are routinely performed during general anesthesia, may induce an inflammatory response in the patient. This inflammatory response is an inherent answer of the body to the intervention and can be both beneficial and potentially harmful. The immune system represents a unique evolutionary achievement equipping higher organisms with an effective defense mechanism against exogenous pathogens. However, not only bacteria might evoke an immune response but also other noninfectious stimuli like the surgical trauma or mechanical ventilation may induce an inflammatory response of varying degree. In these cases, the immune system activation is not always beneficial for the patients and might carry the risk of concomitant, harmful effects on host cells, tissues, or even whole organ systems. Research over the past decades has contributed substantial information in which ways surgical patients may be affected by inflammatory reactions. Modulations of the patient's immune system may be evoked by the use of anesthetic agents, the nature of surgical trauma and the use of any supportive therapy during the perioperative period. The effects on the patient may be manifold, including various proinflammatory effects. This review focuses on the causes and effects of inflammation in the perioperative period. In addition, we also highlight possible approaches by which inflammation in the perioperative may be modulated in the future.http://ift.tt/2BAaVep
Perioperative Cardiac Arrest: Focus on Local Anesthetic Systemic Toxicity (LAST)
No abstract availablehttp://ift.tt/2o5nN4D
Macintosh Blade Videolaryngoscopy Combined With Rigid Bonfils Intubation Endoscope Offers a Suitable Alternative for Patients With Difficult Airways
BACKGROUND: In the armamentarium of an anesthesiologist, videolaryngoscopy is a valuable addition to secure the airway. However, when the videolaryngoscope (VLS) offers no solution, few options remain. Earlier, we presented an intubation technique combining Macintosh blade VLS and Bonfils intubation endoscope (BIE) for a patient with a history of very difficult intubation. In the present study, we evaluated this technique to establish whether it is a valuable alternative. METHODS: In this single-blinded nonrandomized study, 38 patients with a history of difficult intubation or 1 or more predictors of difficult intubation, scoring a Cormack & Lehane (C&L) grade III or IV using Macintosh blade VLS, were included. Patients were intubated combining the VLS with the BIE. The C&L grade was scored 3 times during (1) direct laryngoscopy; (2) indirect videolaryngoscopy; and (3) using the combined technique (VLS + BIE). Afterward, 2 blinded anesthesiologists assessed the C&L grade using the pictures taken during the procedure. RESULTS: Data of 38 patients were analyzed. An improvement of the C&L grade with the combined technique occurred in 33 of 38 patients (86.8%; 95% confidence interval, 71.9%–95.6%). Reviewer 1 reported an improvement of the C&L grade with the combined technique in 37 of 38 patients. Reviewer 2 reported improvement in 33 and deterioration in 2 of the patients. No complications occurred. CONCLUSIONS: The combined use of a VLS with Macintosh blade and BIE gives the anesthesiologist a valuable alternative intubation option in patients with extremely difficult airways.http://ift.tt/2C2xFEM
Perioperative Cardiac Arrest: Focus on Malignant Hyperthermia (MH)
No abstract availablehttp://ift.tt/2odiwXN
Post-Cardiac Arrest Management: Time to Cool It on Cooling?
No abstract availablehttp://ift.tt/2o4NMsD
Efficacy Outcome Measures for Pediatric Procedural Sedation Clinical Trials: An ACTTION Systematic Review
Objective evaluations comparing different techniques and approaches to pediatric procedural sedation studies have been limited by a lack of consistency among the outcome measures used in assessment. This study reviewed those existing measures, which have undergone psychometric analysis in a pediatric procedural sedation setting, to determine to what extent and in what circumstances their use is justified across the spectrum of procedures, age groups, and techniques. The results of our study suggest that a wide range of measures has been used to assess the efficacy and effectiveness of pediatric procedural sedation. Most lack the evidence of validity and reliability that is necessary to facilitate rigorous clinical trial design, as well as the evaluation of new drugs and devices. A set of core pediatric sedation outcome domains and outcome measures can be developed on the basis of our findings. We believe that consensus among all stakeholders regarding appropriate domains and measures to evaluate pediatric procedural sedation is possible and that widespread implementation of such recommendations should be pursued.http://ift.tt/2ExLXPl
The Effect of Adductor Canal Block on Knee Extensor Muscle Strength 6 Weeks After Total Knee Arthroplasty: A Randomized, Controlled Trial
BACKGROUND: Total knee arthroplasty (TKA) reduces knee extensor muscle strength (KES) in the operated limb for several months after the surgery. Immediately after TKA, compared to either inguinal femoral nerve block or placebo, adductor canal block (ACB) better preserves KES. Whether this short-term increase in KES is maintained several weeks after surgery remains unknown. We hypothesized that 48 hours of continuous ACB immediately after TKA would improve KES 6 weeks after TKA, compared to placebo. METHODS: Patients scheduled for primary unilateral TKA were randomized to receive either a continuous ACB (group ACB) or a sham block (group SHAM) for 48 hours after surgery. Primary outcome was the difference in maximal KES 6 weeks postoperatively, measured with a dynamometer during maximum voluntary isometric contraction. Secondary outcomes included postoperative day 1 (POD1) and day 2 (POD2) KES, pain scores at rest and peak effort, and opioid consumption; variation at 6 weeks of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of hospital stay. RESULTS: Sixty-three subjects were randomized and 58 completed the study. Patients in group ACB had less pain at rest during POD1 and during peak effort on POD1 and POD2, consumed less opioids on POD1 and POD2, and had higher median KES on POD1. There was no significant difference between groups for median KES on POD2, variation of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of stay. There was no difference between groups in median KES 6 weeks after surgery (52 Nm [31–89 Nm] for group ACB vs 47 Nm [30–78 Nm] for group SHAM, P= .147). CONCLUSIONS: Continuous ACB provides better analgesia and KES for 24–48 hours after surgery, but does not affect KES 6 weeks after TKA. Further research could evaluate whether standardized and optimized rehabilitation over the long term would allow early KES improvements with ACB to be maintained over a period of weeks or months.http://ift.tt/2ByHqJD
A Retrospective Analysis of Clinical Research Misconduct Using FDA-Issued Warning Letters and Clinical Investigator Inspection List From 2010 to 2014
BACKGROUND: The US Food and Drug Administration (FDA) conducts inspections of clinical investigation sites as a component of clinical trial regulation. The FDA describes the results of these inspections in the Clinical Investigator Inspection List (CLIIL). More serious violations are followed up in FDA warning letters issued to investigators. The primary objective of the current study is to qualitatively and quantitatively describe the CLIIL data and contents of FDA-issued warning letters from 2010 to 2014. METHODS: We retrospectively analyzed the CLIIL and FDA warning letters. For the CLIIL, we quantified the frequency of each violation among other data points. We compared recent data (2010–2014) to the previous 5 years (2005–2009). To analyze FDA warning letters, we developed a coding system to quantify the frequency of violations found. RESULTS: We analyzed 3637 inspections in the CLIIL database and 60 warning letters. Overall, there was a decrease or no change in all violations in the CLIIL database. The largest violation code reported was "failure to follow investigational plan" in both the 2005–2009 and 2010–2014 timeframes. Coding of FDA warning letters shows that the most common violations reported were failing to maintain accurate case histories (10.82%), enrolling ineligible subjects (8.85%), and failing to perform required tests (8.52%). CONCLUSIONS: The overall decrease in violations is encouraging. But, the high proportion of violations related to failure to follow the investigational plan is concerning as the complexity of trials increases. We conclude that more detailed information is necessary to accurately evaluate these violations. The current study provides a model for creating more granular data of violations to better inform clinical investigators and improve clinical trials.http://ift.tt/2C2Vw7s
Chinese Anesthesiologists Have High Burnout and Low Job Satisfaction: A Cross-Sectional Survey
BACKGROUND: The Chinese health care system must meet the needs of 19% of the world's population. Despite recent economic growth, health care resources are unevenly distributed. This creates the potential for job stress and burnout. We therefore conducted a survey among anesthesiologists in the Beijing–Tianjin–Hebei region focusing on job satisfaction and burnout to determine the incidence and associated factors. METHODS: A large cross-sectional study was performed in the Beijing–Tianjin–Hebei region of China. The anonymous questionnaire was designed to collect and analyze the following information: (1) demographic characteristics and employer information; (2) job satisfaction assessed by Minnesota Satisfaction Questionnaire; (3) burnout assessed by Maslach Burnout Inventory-Human Service Survey; and (4) sleep pattern and physician–patient communication. RESULTS: Surveys were completed and returned from 211 hospitals (response rate 74%) and 2873 anesthesiologists (response rate 70%) during the period of June to August 2015. The overall job satisfaction score of Minnesota Satisfaction Questionnaire was 65.3 ± 11.5. Among the participants, 69% (95% confidence interval [CI], 67%–71%) met the criteria for burnout. The prevalence of high emotional exhaustion, high depersonalization, and low personal accomplishment was 57% (95% CI, 55%–59%), 49% (95% CI, 47%–51%), and 57% (95% CI, 55%–58%), respectively. Using multivariable logistic regression analysis, we found that age, hospital category, working hours per week, caseload per day, frequency of perceived challenging cases, income, and sleep quality were independent variables associated with burnout. Anesthesiologists with a high level of depersonalization tended to engage in shorter preoperative conversations with patients, provide less information about pain or the procedure, and to have less empathy with them. CONCLUSIONS: The anesthesiologists in the Beijing–Tianjin–Hebei region of China expressed a below-average level of job satisfaction, and suffered a significant degree of burnout. Improvement in job satisfaction and burnout might create a positive work climate that could benefit both the quality of patient care and the profession of anesthesiology in China.http://ift.tt/2BAaLUl
How can I get rid of milia?
Is it possible to remove milia? We look at home remedies, medical treatments, and ways to prevent these small, white bumps from occurring.
http://ift.tt/2sB69Kx
The Effect of Dermatology Consultation on Outcomes of Patients With Presumed Cellulitis
This randomized clinical trial examines the association of dermatologic consultation with duration of hospital stay and intravenous antibiotic treatment in patients with suspected cellulitis.
http://ift.tt/2BxYbop
http://ift.tt/2BxYbop
Melanocyte Density Counts in Topical Imiquimod-Treated Skin Surrounding Lentigo Maligna
This study examines melanocyte density counts in imiquimod-treated lentigo maligna and negative control biopsy specimens to determine if there was a measurable difference in melanocyte density.
http://ift.tt/2C4okMT
http://ift.tt/2C4okMT
Erythema Nodosum–like Eruption in the Setting of Sorafenib Therapy
This case report describes a patient with erythema nodosum–like eruption in the setting of sorafenib therapy.
http://ift.tt/2ByjqGA
http://ift.tt/2ByjqGA
Outcomes of Early Dermatology Consultation for Inpatients Diagnosed With Cellulitis
This cohort study examines the effects of dermatology consultation on misdiagnosis of cellulitis in patients admitted to emergency departments.
http://ift.tt/2C15RR2
http://ift.tt/2C15RR2
Inpatient Dermatologists—Crucial for the Management of Skin Diseases in Hospitalized Patients
Inpatient dermatology is an emerging subspecialty focused on the care of skin diseases in hospitalized patients. Inpatient dermatologists provide expertise that the primary team and other consultative services lack. The cases encountered in hospital dermatology are often different from those seen in the traditional dermatology outpatient clinic and therefore require dermatologists with specific expertise.
http://ift.tt/2ByiFxa
http://ift.tt/2ByiFxa
How to quantify the 'auditory gain' of a bone-conduction device; comment to the systematic review by Bezdjian et al.
Publication date: Available online 16 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Aren Bezdjian, Hanneke Bruijnzeel, Sam J. Daniel, Hans G.X.M. Thomeer
http://ift.tt/2Hm61BT
Population-based survey of inpatient pediatric tonsillectomy and postoperative hemorrhage in Taiwan, 1997–2012
Publication date: Available online 15 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Wan-Yi Hsueh, Wei-Chung Hsu, Jenq-Yuh Ko, Te-Huei Yeh, Chia-Hsuan Lee, Kun-Tai Kang
ObjectiveTonsil surgery in children is a common surgical procedure, and is mostly performed as an inpatient procedure in Taiwan. This study elucidates the epidemiology and postoperative hemorrhage of inpatient tonsillectomies in Taiwanese children.MethodsThis study used the Taiwan National Health Insurance Research Database for analysis. From 1997 to 2012, all in-hospital children (aged <18 years) who underwent tonsillectomies were identified through the International Codes of Diseases (9th Revision). Incidence rates and trends of inpatient pediatric tonsillectomies during the study period were identified. Major complications, including readmission, reoperation, and mortality were identified. The factors associated with major complications were analyzed.ResultsFrom 1997 to 2012, 17326 children received inpatient tonsillectomies (mean age, 8.6 ± 3.8 y; 65% boys). The overall incidence rate was 20.6 per 100,000 children. The incidence rate was highest in children who were 6–8 years of age, and boys exhibited a higher rate than girls (P < 0.001). Longitudinal data indicated that the incidence rate increased from 1997 (15.7/100,000 children) to 2012 (19.2/100,000 children) (P trend < 0.001). The proportions of readmission for any reason, readmission for bleeding, and reoperation were 1.8%, 0.9%, and 0.3%, respectively. No mortality occurred within 30 days of the tonsillectomy. A multivariable logistic model indicated that toddlers were associated with an increased risk of readmission for any reason (OR, 2.70; 95% CI 1.60–4.56), and adolescents were at risk of bleeding-related readmission (OR, 2.81; 95% CI 1.91–4.14) and reoperation (OR, 2.86; 95% CI 1.47–5.55). Children with comorbidities (OR, 3.14; 95% CI 1.93–5.09) or a surgical indication of tumor (OR, 11.73; 95% CI 4.93–27.91) had a higher risk of readmission. The use of nonsteroidal anti-inflammatory drugs or steroids is associated with an increased risk of readmission or reoperation. Moreover, concurrent procedures (i.e., adenoidectomy, ear surgery, or nasal surgery) did not increase the risk of readmission or reoperation.ConclusionsThe incidence rate and indications of obstructive sleep disorders for inpatient pediatric tonsillectomy increased during 1997–2012 in Taiwan. Postoperative readmission and reoperation were rare. Age, surgical indication, comorbidities, and drug administration were associated with readmission or reoperation in this study cohort.
http://ift.tt/2Gl7oQ6
Three-dimensional assessment of facial asymmetry in preschool patients with orofacial clefts after neonatal cheiloplasty
Publication date: Available online 16 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Veronika Moslerová, Martina Dadáková, Ján Dupej, Eva Hoffmannova, Jiří Borský, Miloš Černý, Přemysl Bejda, Karolína Kočandrlová, Jana Velemínská
ObjectivesTo evaluate facial asymmetry changes in pre-school patients with orofacial clefts after neonatal cheiloplasty and to compare facial asymmetry with age-matched healthy controls.Methods and materialsThe sample consisted of patients with unilateral cleft lip (UCL), unilateral cleft lip and palate (UCLP), and bilateral cleft lip and palate (BCLP). The patients were divided in two age groups with a mean age of 3 years (n = 51) and 4.5 years (n = 45), respectively, and 78 age-matched individuals as controls. Three-dimensional (3D) facial scans were analyzed using geometric morphometry and multivariate statistics.ResultsGeometric morphometry showed positive deviations from perfect symmetry on the right side of the forehead in the intervention groups and the controls. The UCL groups showed the greatest asymmetric nasolabial area on the cleft-side labia and the contralateral nasal tip. The UCLP group showed, moreover, asymmetry in buccal region due to typical maxillar hypoplasia, which was accentuated in the older group. The BCLP groups showed slightly similar but greater asymmetry than the control groups, except for the philtrum region.ConclusionsAsymmetry of each of the cleft groups significantly differed from the controls. Except for the buccal region in the UCLP and BCLP groups, asymmetry did not significantly increase with age.
http://ift.tt/2HjCau5
Pazopanib effective for bevacizumab-unresponsive epistaxis in hereditary hemorrhagic telangiectasia
Hereditary hemorrhagic telangiectasia (HHT) most commonly manifests with nasal mucosal telangiectasias, and vascular endothelial growth factor (VEGF) plays a significant role in this angiodysplasia. We describe a patient with HHT with epistaxis recalcitrant to several endonasal procedures and six cycles of intravenous bevacizumab, for which he was dependent on iron infusions and packed red blood cells transfusions. He then started pazopanib at 100 mg with dramatic improvements in epistaxis and normalization of hemoglobin and iron levels, without replenishment needs for 12 months. This is the first report on the efficacy of pazopanib with high selectivity for abrogating VEGF receptor-2 signaling in HHT, and needs to be explored further. Laryngoscope, 2018
http://ift.tt/2o9Mxb2
A long-term comparative prospective study between reinnervation and injection laryngoplasty
Objectives
This study compared and assessed long-term voice outcomes when thyroidectomy-related unilateral vocal fold paralysis (VFP) was managed using injection laryngoplasty (IL) and recurrent laryngeal nerve reinnervation (RLNR).
Study Design
Prospective clinical study.
Methods
A prospective clinical trial was performed from March 2005 to January 2016 at Soonchunhyang University Bucheon Hospital (Bucheon, South Korea). Nineteen patients who underwent ansa cervicalis to RLNR or direct reinnervation, and 43 patients who underwent IL to treat thyroidectomy-related unilateral VFP, were enrolled.
Results
All voice parameters exhibited statistically significant improvement 12 months post-IL, which persisted for 24 and 36 months (P < 0.05). However, at 36 months post-IL, some voice parameters had deteriorated relative to the values at 24 months post-IL. After RLNR, all voice parameters exhibited statistically significant improvement after 12 months, and the improvements remained stable until 36 months postsurgery without deterioration of voice parameters (P < 0.05). At 36 months, RLNR provided better voice results than IL (P < 0.05).
Conclusion
Both RLNR and IL yielded statistically significant voice improvements at 36 months postoperatively. However, after 36 months, RLNR provided better results than IL.
Level of Evidence
III. Laryngoscope, 2018
http://ift.tt/2o4HNV1
Using quantitative tissue phenotype to assess the margins of surgical samples from a pan-Canadian surgery study
Abstract
Background
The purpose of this study was to use quantitative tissue phenotype (QTP) to assess the surgical margins to examine if a fluorescence visualization-guided surgical approach produces a shift in the surgical field by sparing normal tissue while catching high-risk tissue.
Methods
Using our QTP to calculate the degree of nuclear chromatin abnormalities, Nuclear Phenotypic Score (NPS), we analyzed 1290 biopsy specimens taken from surgical samples of 248 patients enrolled in the Efficacy of Optically-guided Surgery in the Management of Early-staged Oral Cancer (COOLS) trial. Multiple margin specimens were collected from each surgical specimen according to the presence of fluorescence visualization alterations and the distance to the surgical margins.
Results
The NPS in fluorescence visualization-altered (fluorescence visualization-positive) samples was significantly higher than that in fluorescence visualization-retained (fluorescence visualization-negative) samples. There was a constant trend of decreasing NPS of margin samples from non-adjacent-fluorescence visualization margins to adjacent-fluorescence visualization margins.
Conclusion
Our results suggested that using fluorescence visualization to guide surgery has the potential to spare more normal tissue at surgical margins.
http://ift.tt/2sxJvCR
Time course and clinical characterization of cisplatin-induced ototoxicity after treatment for nasopharyngeal carcinoma in a South East Asian population
Abstract
Background
The purpose of this study was to characterize the clinical course of hearing loss in patients with nasopharyngeal carcinoma (NPC) and the clinical factors affecting its severity.
Methods
The time course of hearing loss in patients with NPC was assessed using threshold shift from baseline and Common Terminology Criteria for Adverse Events (CTCAE) grade.
Results
In the chemoradiotherapy (CRT) groups, the threshold shift was significantly higher from 3 months at 4 kHz (P = 2.30 × 10−9, concurrent CRT only) but not within 2 years posttreatment in the radiotherapy (RT) group. The CRT groups had worse CTCAE grades than the RT group (percentage of latest CTCAE grade ≥1: 64.9% vs 29.0%, respectively). Cumulative cisplatin dose and cochlear RT dose significantly affects threshold shifts, especially at high frequencies.
Conclusion
Although cisplatin led to high frequency hearing impairment from about 3 months posttreatment, RT conferred no significant hearing impairment in the first 2 years.
http://ift.tt/2EMjRzi
Patterns of care and outcomes of adjuvant therapy for high-risk head and neck cancer after surgery
Abstract
Background
Postoperative chemoradiotherapy (CRT) is considered standard of care in patients with locally advanced head and neck cancer with positive margins and/or extracapsular extension (ECE).
Methods
The National Cancer Data Base (NCDB) was queried to identify patients with squamous cell carcinoma of the head and neck with stages III to IVB disease or with positive margins and/or ECE diagnosed between 2004 and 2012 receiving postoperative radiotherapy (RT). Using univariable and multivariable logistic and Cox regression, we assessed for predictors of CRT use and covariables impacting overall survival (OS), including in a propensity-matched subset.
Results
Of 12 224 patients, 67.1% with positive margins and/or ECE received CRT as well as 54.0% without positive margins and/or ECE. The 5-year OS was 61.6% for RT alone versus 67.4% for CRT. In the propensity-matched cohort, OS benefit persisted with CRT, including in a subset with positive margins and/or ECE but not without.
Conclusion
Postoperative CRT seems underutilized with positive margins and/or ECE and overutilized without positive margins and/or ECE. The CRT was associated with improved OS but the benefit persisted only in the subset with positive margins and/or ECE.
http://ift.tt/2swMImd
Mechanism for Initiation of Food Allergy: Dependence on skin barrier mutations and environmental allergen co-stimulation
Publication date: Available online 15 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Matthew Walker, Jeremy Green, Ryan Ferrie, Ashley Queener, Mark H. Kaplan, Joan M. Cook-Mills
BackgroundMechanisms for the development of food allergy in neonates are unknown but are clearly linked in patient populations to a genetic predisposition towards skin barrier defects. Whether skin barrier defects functionally contribute to development of food allergy is unknown.ObjectiveThe purpose of the study was to determine whether skin barrier mutations, that are primarily heterozygous in patient populations, contribute to the development of food allergy.MethodsMice heterozygous for the Flgft and Tmem79ma mutations were skin sensitized with environmental allergens and food allergens. After sensitization, mice received oral challenge with food allergen and then inflammation, inflammatory mediators, and anaphylaxis were measured.ResultsWe define development of inflammation, inflammatory mediators, and food allergen-induced anaphylaxis in neonatal mice with skin barrier mutations following brief concurrent cutaneous exposure to food and environmental allergens. Moreover, neonates of allergic mothers have elevated responses to suboptimal sensitization with food allergens. Importantly, the responses to food allergens by these neonatal mice were dependent on genetic defects in skin barrier function and on exposure to environmental allergens. Blockade of ST2 during skin sensitization inhibited development of anaphylaxis, antigen-specific IgE and inflammatory mediators. The neonatal anaphylactic responses and antigen-specific IgE were also inhibited by oral pre-exposure to food allergen but, interestingly, this was blunted by concurrent pre-exposure of the skin to environmental allergen.ConclusionThese studies uncover mechanisms for food allergy sensitization and anaphylaxis in neonatal mice that are consistent with features of human early life exposures and genetics in clinical food allergy and demonstrate that changes in barrier function drive development of anaphylaxis to food allergen.
http://ift.tt/2ExAQlh
Recurrent epistaxis leading to diagnosis of primary sinonasal melanoma
A 48-year-old man presented to urgent care with recurrent epistaxis over 6 months. Initially, nosebleeds were controlled with packing or cautery. Ultimately, he was referred to ear, nose and throat department and underwent nasal endoscopy which revealed polypoid tissue. A biopsy of the polyp showed non-specific inflammation with no evidence of malignancy. Follow-up maxillofacial CT revealed a large mass lesion in the right maxillary sinus, right nasal fossa, much of the ethmoids and right sphenoid, with destruction of adjacent bony structures. MRI revealed a mass in the right nasal cavity with extension into the ethmoid and anterior sphenoid sinus, anterior cranial fossa and medial orbits. Staging CT discovered metastatic disease in the adrenal glands and lymphadenopathy in the neck. The patient underwent endoscopic sinus surgery with debulking and tissue diagnosis of malignant melanoma. He completed radiation therapy to sinus and was subsequently enrolled in a clinical trial. Most recent imaging revealed complete metabolic response on positron emission tomography.
http://ift.tt/2HmIe4Y
Polymicrobial bacterial pericarditis and cardiac tamponade caused by pericardial penetration of an adjustable gastric band
We describe a case of polymicrobial bacterial pericarditis with Klebsiella pneumoniae and Proteus mirabilis, caused by pericardial penetration of the tip of the catheter of a laparoscopic adjustable gastric band (LAGB). The patient developed a cardiac tamponade, and subsequently emergency pericardiocentesis was performed. Analysis of earlier CT scans showed that the tip of the catheter had migrated through the liver and through the diaphragm into the pericardium, and was in contact with the myocardium. After stabilisation he was operated to remove the LAGB. In this case report, we describe the chain of events that led to the polymicrobial pericarditis—a complication of LAGB placement that to our knowledge has thus far never been reported. We furthermore present a detailed literature review of all published cases of polymicrobial pericarditis and its causes.
http://ift.tt/2Gl9a3U
Renal nutcracker syndrome in a young lady: unusual findings and endovascular management
Nutcracker syndrome (NCS) is caused by compression of left renal vein (LRV), usually between the aorta and the superior mesenteric artery (SMA). This can lead to obstruction of flow into the inferior vena cava and secondary left renal venous hypertension. Despite potential serious consequences, diagnosing NCS is often challenging, circuitous and commonly delayed. We report an extremely unique case of NCS. A 34-year-old woman presented with left flank pain and discomfort. On investigation, it was found that high pressure in the LRV, due to compression by the SMA, had led to a large venous aneurysm that had caused pelviureteric junction obstruction and hydronephrosis. Management was with stenting of the LRV and coil embolisation of the venous aneurysm with excellent clinical outcome.
http://ift.tt/2HnvoUc
Fistulation between a colonic J-Pouch and the upper vagina in an irradiated pelvis: a rare complication following low anterior resection with colonic J-pouch anal anastomosis for rectal cancer
Formation of a colonic J-pouch with anastomosis to the rectal stump is an accepted form of reconstruction after low anterior resection (LAR) for rectal carcinoma. It is thought this can help prevent the onset of LAR syndrome as well as improve the quality of life in the first two years following surgery. Rectovaginal fistulation is a recognised complication of this form of surgery usually occurring because of technical failure leading to inclusion of the vaginal wall into the stapled anastomosis. We present an as of yet unreported case of fistulation between the upper horizontal staple line of a colonic J-pouch—the tip of the 'J'—which was formed extracorporeally with the posterior vaginal fornix. We postulate that pelvic irradiation was partly a causative factor alongside subsequent mechanical irritation. Ultimately, surgical intervention was required, following which the patient made a full recovery. Interposition of omentum may prevent this problem.
http://ift.tt/2GjtAKs
The cat did it: erythema nodosum and additional atypical presentations of Bartonella henselae infection in immunocompetent hosts
A healthy patient presented with painful skin lesions on the anterior surface of her legs. Erythema nodosum was diagnosed but all the usual causes were ruled out. The finding of bilateral enlarged axillary lymph nodes with necrosis and granulomas led to the diagnosis of Bartonella infection, an unusual cause of erythema nodosum. Imaging also revealed splenomegaly and small para-aortic lymph nodes. Up to one quarter of the patients with cat-scratch disease present atypically, a considerably higher prevalence than previously reported. A comprehensive review of the literature (PubMed, since inception, all languages) revealed a remarkable array of unusual presentations which are summarised and briefly discussed.
http://ift.tt/2HjDltk
Implant of a left atrial appendage occluder device (Watchman) and leadless pacing system (Micra) through the same venous access in a single sitting
A left atrial appendage occluder device (Watchman) and leadless pacemaker (Micra) was implanted from a single right femoral vein access in a 73-year-old female patient with persistent atrial fibrillation and symptomatic tachy-brady syndrome and unable to take oral anticoagulants. Standard methods of implantation were followed for both procedures. The Watchman device was implanted first followed by dilatation of the same venous access site in order to implant Micra transcatheter pacing system. The patient tolerated the procedures well and there were no complications. At the end of 1 month, both the devices were found to be working well.
http://ift.tt/2Giyffx
Syncope and cardiogenic shock in an 80-year-old woman
Description
An 80-year-old woman presented with a 2-day history of breathlessness and syncope. Her medical history included Parkinson's disease and a recent diagnosis of myelodysplasia for which she had undergone a (painful) bone marrow aspiration 2 days earlier.
Presentation blood pressure (BP) was 69/38 mm Hg (and fell further to 59/40 mm Hg with impaired conscious level), heart rate 78, respiratory rate 17 and oxygen saturation 100% on air. Her presentation of ECG revealed anteroseptal Q waves with 1 mm ST segment elevation (figure 1).
Figure 1
A 12-lead ECG at presentation.
Emergency primary percutaneous coronary intervention was declined due to the probability of established myocardial infarction with consequent cardiogenic shock. Medical treatment and inotropic therapy with intra-aortic balloon pump (IABP) were directed. She underwent emergency portable echocardiography to understand the aetiology for cardiogenic shock.
The panel of images (figure 2A–C)...
http://ift.tt/2HleCVN
Making a difference in the developing world
By Marcus Chong
In 2016, while conducting medical research in a rural village of Northern Samar, the Philippines, Professor Allen Ross and his global health research team met a patient with severe electrical burns. He was a construction worker who had suffered an electrical burn at work from an overhanging high voltage electrical wire carrying 20,000 Volts. He had sustained burns to 25% of his body with significant scarring on the skin under the armpits and the amputation of all four limbs.
After the accident, he was transported to a local hospital by a family member; he remained there without medical treatment for eight hours. Public hospitals in Metro Manila are typically overwhelmed – with a lack of physicians available to treat emergency patients. Approximately eight hours later an ambulance was found to transport the patient to a local burns centre. By then his untreated injuries had resulted in thromboses requiring amputations of all four limbs. His relative in Manila sold their company truck in order to pay for his surgical procedures and hospital care. He remained in hospital for a few weeks after the operation. At this point his family had used up all their savings. He was discharged in a wheelchair as physiotherapy, prostheses and rehabilitation were prohibitively expensive. He returned to his home village in Simora Palapag, Northern Samar (Image, left).
The published BMJ case report that resulted can be found here.
In 2017, with the patient and family's consent, Thao Ross (Allen's wife) organised crowd funding on a Go-fund-me website. Funds came from people of all walks of life. It took several months to raise the required funds for four prosthetic limbs.
We were able to buy prostheses made of aluminium and coated with an alloy that made them durable and water-proof in Manila, from the prosthetic limb company Ottobock. There were also sufficient funds to provide the patient with rehabilitation and prosthetic fitting services. The prostheses provided by the company for the lower limbs can be seen in the above image (right) and the patient is currently (2018) having his upper limbs custom made and fitted. The patient was able to walk again after a few weeks of physiotherapy and rehabilitation. The patient waited almost seven years to walk again and we are very happy to have made this possible!
Competing Interests
None Declared
http://ift.tt/2obtZqV
Bivalirudin for Pediatric Procedural Anticoagulation: A Narrative Review
Bivalirudin (Angiomax; The Medicines Company, Parsippany, NJ), a direct thrombin inhibitor, has found increasing utilization as a heparin alternative in the pediatric population, most commonly for the treatment of thrombosis secondary to heparin-induced thrombocytopenia. Due to the relative rarity of heparin-induced thrombocytopenia as well as the lack of Food and Drug Administration–approved indications in this age group, much of what is known regarding the pharmacokinetics and pharmacodynamics of bivalirudin in this population has been extrapolated from adult data. This narrative review will present recommendations regarding the use of bivalirudin for procedural anticoagulation in the pediatric population based on the published literature. Accepted for publication December 19, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Katherine L. Zaleski, MD, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115. Address e-mail to Katherine.Zaleski@childrens.harvard.edu. © 2018 International Anesthesia Research Society
http://ift.tt/2Eu17oG
http://ift.tt/2Eu17oG
Combined Colloid Preload and Crystalloid Coload Versus Crystalloid Coload During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial
BACKGROUND: The optimal strategy of fluid administration during spinal anesthesia for cesarean delivery is still unclear. Ultrasonography of the inferior vena cava (IVC) has been recently used to assess the volume status and predict fluid responsiveness. In this double-blind, randomized controlled study, we compared maternal hemodynamics using a combination of 500-mL colloid preload and 500-mL crystalloid coload versus 1000-mL crystalloid coload. We assessed the IVC at baseline and at subsequent time points after spinal anesthesia. METHODS: Two hundred American Society of Anesthesiologists physical status II parturients with full-term singleton pregnancies scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either 500-mL colloid preload followed by 500-mL crystalloid coload (combination group) or 1000-mL crystalloid coload (crystalloid coload group) administered using a pressurizer. Ephedrine 3, 5, and 10 mg boluses were administered when the systolic blood pressure decreased below 90%, 80% (hypotension), and 70% (severe hypotension) of the baseline value, respectively. The IVC was assessed using the subcostal long-axis view at baseline, at 1 and 5 minutes after intrathecal injection, and immediately after delivery; the maximum and minimum IVC diameters were measured, and the IVC collapsibility index (CI) was calculated using the formula: IVC-CI = (maximum IVC diameter – minimum IVC diameter)/maximum IVC diameter. The primary outcome was the total ephedrine dose. RESULTS: Data from 198 patients (99 patients in each group) were analyzed. The median (range) of the total ephedrine dose was 11 (0–60) mg in the combination group and 13 (0–61) mg in the crystalloid coload group; the median of the difference (95% nonparametric confidence interval) was −2 (−5 to 0.00005) mg, P = .22. There were no significant differences between the 2 groups in the number of patients requiring ephedrine, the incidence of hypotension and severe hypotension, the time to the first ephedrine dose, and neonatal Apgar scores at 1 and 5 minutes. The maximum and minimum IVC diameters in each group increased after spinal anesthesia and after delivery, and they were larger in the combination group. The IVC-CI after delivery was higher in the crystalloid coload group. CONCLUSIONS: The combination of 500-mL colloid preload and 500-mL crystalloid coload did not reduce the total ephedrine dose or improve other maternal outcomes compared with 1000-mL crystalloid coload. The IVC was reliably viewed before and during cesarean delivery, and its diameters significantly changed over time and differed between the 2 groups. Accepted for publication December 29, 2017. Funding: This work was supported by the Department of Anesthesia and Surgical Intensive Care at the Mansoura University Hospital, Mansoura, Egypt. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Clinical trial registration: NCT02961842 (ClinicalTrials.gov). The institutional review board approved the study protocol before starting the study; Mansoura Faculty of Medicine Institutional Review Board, http://ift.tt/2Eu0StM, Ahmed Shokeir, MD (Chairman), Professor of Urology, Faculty of Medicine, Mansoura University, Mansoura, Egypt. E-mail: irb.mfm@hotmail.com. Reprints will not be available from the authors. Address correspondence to Mohamed Mohamed Tawfik, MD, Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospital, 26 Elgomhoria St, Mansoura, Dakahlia, Egypt. Address e-mail to m2tawfik@mans.edu.eg. © 2018 International Anesthesia Research Society
http://ift.tt/2CpUeyI
http://ift.tt/2CpUeyI
Neuraxial Anesthesia in Children With Ventriculoperitoneal Shunts
Neuraxial anesthesia has been demonstrated to be safe and effective for children undergoing subumbilical surgery. There is limited evidence regarding the safety of neuraxial anesthesia in pediatric patients with a ventriculoperitoneal shunt. We evaluated a series of 25 patients with indwelling ventriculoperitoneal shunts for complications within 30 days of any procedure performed with a neuraxial technique. One patient required a ventriculoperitoneal shunt revision 5 days after a lumbar catheter placement. The neurosurgeon determined the revision to be likely unrelated to the patient's lumbar catheter. Concerns about the use of neuraxial anesthesia in patients with an indwelling ventriculoperitoneal shunt may be overstated. Accepted for publication December 19, 2018. Funding: None. The authors declare no conflicts of interest. A.B.L. and E.C.C. contributed equally to this work. Reprints will not be available from the authors. Address correspondence to Anthony B. Longhini, MD, Department of Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611. Address e-mail to alonghini@luriechildrens.org. © 2018 International Anesthesia Research Society
http://ift.tt/2EAooW3
http://ift.tt/2EAooW3
The role of feedback in ameliorating burnout
Purpose of review Assessment of the current literature surrounding interventions directed toward the prevention of burnout in the field of medicine and particularly in anesthesiology. Recent findings Recently, burnout has been noted to lead to medication errors and subsequently increased harm to our patients. On a personal level, burnout can lead to depression and even suicide amongst physicians. Strategies to prevent burnout amongst anesthesiologists that have been studied in the literature include multisource feedback, mentorship and early recognition. Summary There remains no clear or definitive intervention to prevent burnout for physicians. However, changing our environment to embrace mentorship, the continual exchange of feedback and the fostering self-care could startlingly improve our work environment. Correspondence to Emily K. Gordon, MD, MSEd, Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, 3400 Spruce Street, 6 Dulles Building, Philadelphia, PA 19104, USA. Tel: +1 267 977 7203; e-mail: emily.gordon@uphs.upenn.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2HmTbUg
http://ift.tt/2HmTbUg
Sinonasal seromucinous hamartoma
Abstract
Introduction
Seromucinous hamartoma (SH) is a rare benign glandular proliferation of the sinonasal tract and nasopharynx. Only few cases have been reported in recent years.
Materials and methods
We performed a retrospective medical record review of seven patients diagnosed with sinonasal SH who underwent endoscopic endonasal surgery.
Results
There were 5 males and 2 females, ranged in age from 40 to 98 years (mean 60 years, SD ± 18.9). Two lesions arise from middle turbinate, two from uncinate process, and 3 (but 4 specimens) from nasal septum. Pathological features revealed a polypoid lesion with submucosal proliferation of seromucinous glands arranged in lobular and haphazard patterns. In immunohistochemical study, the seromucinous glands of SH were reactive for cytokeratin, including CK7, CK19, HMWK, but negative for CK20.
Conclusion
Sinonasal SH is a rare diagnosis characterized by a polypoid lesion with a haphazard proliferation of seromucinous glands. The rhinologists should consider it in the differential diagnosis of a polypoid lesion in the nasal cavity.
http://ift.tt/2o9ps8o
Value of double pedicled mucoperiosteal flaps for the prevention of restenosis in Draf IIb frontal sinusotomy
Publication date: Available online 16 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N. Khoueir, B. Verillaud, P. Herman
IntroductionThe extent of bone exposure is one of the major factors contributing to failure of endoscopic frontal sinusotomy procedures. Double flaps providing cover of exposed bone have already been described for Draf III procedures in a cadavre study using posterior and lateral pedicled nasoseptal flaps. As these flaps overlap on the septal side, they cannot be raised from the same nasal cavity in a Draf IIb procedure. We describe a new technique using 2 local mucoperiosteal flaps raised from the same side to entirely cover the bone margins exposed by Draf IIb frontal sinusotomy.Surgical techniqueA left Draf IIb procedure was performed to drain a frontal mucocele. A posterior septoturbinal flap (PSTF) was raised to cover the posterior sinusotomy margin. A lateral pedicle nasoseptal flap (LNSF) was raised on the same side to cover the anterior margin. With a follow-up of 6 months, the Draf IIb cavity was fully patent and the flaps were well integrated.ConclusionPSTF and LNSF flaps can be raised on the same side to cover the posterior and anterior margins of the Draf IIb frontal sinusotomy, respectively.
http://ift.tt/2suq6CE
Eosinophil-derived exosomes contribute to asthma remodelling by activating structural lung cells
Abstract
Background
Eosinophils, a central factor in asthma pathogenesis, have the ability to secrete exosomes. However, the precise role played by exosomes in the biological processes leading up to asthma has not been fully defined.
Objective
We hypothesised that exosomes released by eosinophils contribute to asthma pathogenesis by activating structural lung cells.
Methods
Eosinophils from asthmatic patients and healthy volunteers were purified from peripheral blood, and exosomes were isolated from eosinophils of asthmatic and healthy individuals. All experiments were performed with eosinophil-derived exosomes from healthy and asthmatic subjects. Epithelial damage was evaluated using primary small airway epithelial cell lines through 2 types of apoptosis assays, i.e. flow cytometry and TUNEL assay with confocal microscopy. Additionally, epithelial repair was analysed by performing wound healing assays with epithelial cells. Functional studies such as proliferation and inhibition-proliferation assays were carried out in primary bronchial smooth muscle cell lines. Also, gene-expression analysis of pro-inflammatory molecules was evaluated by Real-Time PCR on epithelial and muscle cells. Lastly, protein expression of epithelial and muscle-cell signalling factors was estimated by Western blot.
Results
Asthmatic eosinophil-derived exosomes induced an increase in epithelial cell apoptosis at 24 h and 48 h, impeding wound closure. In addition, muscle-cell proliferation was increased at 72 h after exosome addition and was linked with higher phosphorylation of ERK1/2. We also found higher expression of several genes when both cell types were cultured in the presence of exosomes from asthmatics: CCR3 and VEGFA in muscle cells, and CCL26, TNF, and POSTN in epithelial cells. Healthy eosinophil-derived exosomes did not exert any effect over these cell types.
Conclusions and Clinical Relevance
Eosinophil-derived exosomes from asthmatic patients participate actively in the development of the pathological features of asthma via structural lung cells.
This article is protected by copyright. All rights reserved.
http://ift.tt/2Ewolqg
Primary sebocytes and sebaceous gland cell lines for studying sebaceous lipogenesis and sebaceous gland diseases
Abstract
Sebocytes, the major cell type in sebaceous glands (SGs), are differentiated epithelial cells that gradually accumulate lipids and eventually disrupt, releasing their content (sebum) in a secretory process known as holocrine secretion. Via the hair canal, sebum reaches the skin surface, where it has several known or postulated functions, including pheromonal, thermoregulatory, antimicrobial and antioxidant activities. Altered sebum secretion and/or structural SG changes have also been involved in the pathogenesis of skin diseases, such as acne vulgaris and some forms of alopecia. Here we assess how recent work employing primary sebocytes and SG cell lines contributed for our understanding of sebaceous lipogenesis and its role in skin health and disease.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oapoFf
Dermatology Training Across the Globe, Part II: A summary of the literature
Abstract
In the United States (U.S.), dermatology training program rankings often stem from assessments by practicing physicians or evaluations of scholarly achievements such as grants and publicatons.1 To the best of our knowledge, similar ranking systems outside of the U.S. do not exist. In fact, outside of the U.S., dermatology departments are assessed in alternative ways such as utilization of inpatient bed capacity, research funding, and metrics of patient care.
This article is protected by copyright. All rights reserved.
http://ift.tt/2CrbXG8
Successful therapy of Pyoderma gangrenosum with a JAK2 inhibitor
Abstract
Pyoderma gangrenosum (PG) is a rare, solitary or multiple, chronically progressive, painful, destructive, sterile neutrophil inflammation of unexplained aetiology and pathogenesis, which often remains resistant to treatment. An autoimmunological and autoinflammatory genesis is discussed, which is the main reason why there are so many immunosupressant therapies available. PG may occur in association with inflammatory and haematological disorders, such as Crohn's disease, myeloma, leukaemia, lymphoma and polycythemia vera (PV), as it is the case in our patient presented here.
This article is protected by copyright. All rights reserved.
http://ift.tt/2Ex9ct1
Optimizing case reports and case series: guidance on how to improve quality
Abstract
Case reports and case series remain an important part of journals and are often first to document medical breakthroughs. This article reviews their characteristics, aims and limitations. It provides information on how to increase the validity of the bedside decision-making process that these studies report, using tools such as validated outcomes and split body or n-of-1 trials. A section describing tools to improve writing of case reports and case series provides suggestions for detailed reporting and good evaluation of novelty, validity and relevance. It includes general and British Journal of Dermatology specific guidance.
This article is protected by copyright. All rights reserved.
http://ift.tt/2CsFAqQ
Acute psychosocial stress downregulates N-Methyl-d-aspartate receptors (NMDAR) in healthy human skin
Abstract
Psychosocial stress impacts both healthy and diseased skin1. Whilst acute stress activates the Hypothalamic-Pituitary-Adrenal (HPA) axis, chronic stress induces suppression and impairs wound healing in humans and animals1,2. Although the underlying pathomechanisms are yet to be fully elucidated, it is clear that a better understanding of the complex relationship between neuroendocrine pathways, the immune system and the skin (the "brain-skin axis") is pivotal to the optimal management of both stress-responsive dermatoses and cutaneous wound healing.
This article is protected by copyright. All rights reserved.
http://ift.tt/2Ewg89r
You Think It’s Ok But It’s “Snot”
Another winter cold and flu season is well underway and I find myself staring in disbelief at the amount of fluorescent green mucus dripping from my son's raw nose. I start trying to count how many days it's been since I've seen his nose NOT full of snot. Let's see… 1,2,3….8. Ok so it's been 8 days this time. I'm not sure it's getting better but he seems fine. The only thing bothering him is his mother constantly trying to wipe his nose. At this thought, I reach over and attempt to clear out his nose with a tissue for the hundredth time today. He pushes my hand away again and wipes his drippy nose on his sleeve. At 9-years-old he knows he does NOT like the taste of Sudafed or Mucinex and would rather have a root canal than let me spray Afrin in his nose. He simply doesn't care that he cannot breathe through his nose and that his mother is grossed out. He's fine. So I wait another couple of days and then, "poof," the snot has disappeared as if it were never been there in the first place.
Not the flu, not a sinus infection, just a "common cold" and there was nothing I could do but wait it out.
Winter brings a variety of generally benign respiratory viruses that cause the "common cold" or "viral upper respiratory infection." Young children in daycare can have 8-10 colds a year and most of these will fall during the winter months. Influenza is a respiratory virus that causes a more significant "cold." Kids with influenza or "the flu" look and feel sicker than they would with a cold. Sinus infections can follow the flu or a common cold and can sometimes be difficult to separate from the back-to-back colds (aka "daycare boogies") that young children catch in daycare. Sinusitis in older children will often have more classic symptoms of headaches and sinus pain or pressure while diagnosis in younger children may be based on duration of runny nose or cough or prolonged or returning fever. Color of nasal drainage is not an indicator of one type of infection over another. Snot can take on the colors of the rainbow in any infection – viral or bacterial.
Picture this: A playful child with low grade fever for 3-4 days, runny nose, coughing and congestion. These symptoms gradually worsened over the first 4-5 days but then level off for a couple of days and are begin to improve in the second week of illness. By 2 weeks, this child is free of symptoms.
This is the common cold
Now picture this: A slightly less playful child with coughing, congestion or runny nose for 2 or more weeks, worsening after the first 7-10 days or fever returning after resolving. Was more playful and recently has become less active and more tired. Fever had resolved after the first 3-4 days of illness then returns on day 8 of symptoms. Additional symptoms common in older children include headaches, sinus pain or pressure, tooth pain.
This is a sinus infection
And finally this: A very unhappy, tired, ill appearing child with sudden onset of sore throat, chills, fever to 104, body aches, congestion and coughing. Symptoms remain unchanged for 5-7 days, then fever resolves and the child begins to regain appetite and activity. Once the fever has resolved for 24 hours, it does not return and the coughing does not worsen after the first 5-7 days of illness.
This is influenza
Helping your child feel better
If you suspect a sinus infection, your child should see seen by your pediatrician. If you suspect influenza, you should talk to you pediatrician, who may then want to see your child. Antibiotics are used to treat sinus infections. Your doctor may recommend Tamiflu under certain circumstances for influenza but this is not a cure like an antibiotic will be for a sinus infection. The best "treatment" for influenza is still PREVENTION with yearly flu shots. Even during years when the flu vaccine is not as effective, it still effectively decreases the severity of illness as well as prevents complications and death from influenza infection. Would you rather feel like you were "hit by a mack truck" without the flu vaccine or feel like you have a really, bad cold with some bodyaches and fever with the flu vaccine? Get the vaccine.
There is no treatment for the "common cold" and more children are not as bothered by their symptoms as their worried parents tend to be. It's important to keep in mind that if you child is drinking, sleeping and generally feeling and acting well, you do not need to treat their cold symptoms.
Tips for 2 of the more annoying symptoms of upper respiratory illnesses.
Nasal congestion
-If your child is older than 4, you can use over-the-counter medications to relieve nasal congestion. Nasal congestion can interfere with sleeping and eating. Mucinex and Sudafed both have pediatric preparations and can be helpful in improving nasal congestion. Afrin nasal spray works very well to decrease congestion and can be used for up to 3 days. These medications also help with the postnasal drainage that many children find annoying when dealing with a cold, flu or sinus infection
-Younger children can find relief from nasal congestion with saline drops and nasal suction. The Nose Frida has become a very popular suction device, particularly for young infants with nasal congestion. Nasal congestion in young infants can make feeding and breathing through the nose very difficult. Many parents of young infants find themselves praising the Nose Frida!
-Cool mist humidifier or vaporizer helps with congestion and coughing in all ages
-Hydrate!
Coughing
-If over the age of 12months, you can use honey for coughing. Honey is a natural cough suppressant and has the ability to thin mucus and help with postnasal drainage which is often triggering coughing. You can give the honey on a teaspoon or in warm tea or water.
-Young infants can get some cough relief from snot suction (as above), humidifier in room and elevation of the crib mattress for sleep. Do not put a pillow or any other bolster directly under infant's head to create the incline.
-Hydrate!
When to call your doctor about upper respiratory symptoms
-Anytime you are concerned
-Fever more than 3 days in a child more than 3 months of age
-When the child is not drinking
-Any worsening symptoms after a week
-Fever that recurs after initial resolution
-Child is having trouble breathing
-Infant under 3 months of age
-Signs of influenza
The post You Think It's Ok But It's "Snot" appeared first on ChildrensMD.
http://ift.tt/2EtXajQ
Developing competent videofluoroscopic swallowing study analysts
Purpose of review This review examines the recent literature concerning the development of VFSS analysts. Recent findings Face-to-face and blended methods of training improve reliability and accuracy of VFSS analysis. However, with the exception of the literature describing the MBSImP training, most studies investigate relatively brief training for specific VFSS rating tools. The influence of training mode and trainee factors has received limited attention. Summary There is a lack of controlled studies investigating the influences of training methods for VFSS analysis. Pilot data is emerging concerning VFSS analysis training 'packages' but without information about the relative influence of training mode, it is difficult to determine the most efficient and cost-effective way of training VFSS analysts. Future research should investigate the contribution of trainee-related factors to succeed in VFSS analysis training, and the relative benefits and disadvantages of online, peer, independent, and blended modes of training. Correspondence to Ann Edwards, School of Allied Health, Australian Catholic University, Room 203.2.05, 1100 Nudgee Rd, PO Box 456, Banyo, QLD 4014, Australia. Tel: +61 7 3861 6091; e-mail: ann.edwards@acu.edu.au Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2EvPZ6O
http://ift.tt/2EvPZ6O
Health surveillance for occupational asthma
Purpose of review The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma. Recent findings The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance. Summary Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate. Correspondence to David Fishwick, MBChB, FRCP, AFOM, MD, Centre for Workplace Health, Science Division, Health and Safety Executive of Great Britain, Harpur Hill, Buxton, Derbyshire, SK179JN, UK. Tel: +0203 028 2214; e-mail: d.fishwick@sheffield.ac.uk;david.fishwick@hsl.gsi.gov.uk The contents of this publication reflect the views of the authors alone and not necessarily those of HSE policy. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2F92Htu
http://ift.tt/2F92Htu
Children with Facial Morphea Managing Everyday Life: A Qualitative Study
Summary
Background
This study explores the everyday experiences of children with facial morphea by examining the psychosocial impact of living with facial morphea and how children and their families manage its impact.
Methods
We used a qualitative, social constructionist approach involving focus groups, in-depth interviews and drawing activities with 10 children with facial morphea 8-17 years of age and 13 parents. Interpretive thematic analysis was utilized to examine the data.
Results
Children and parents reported on the stress of living with facial morphea, which was related to the lack of knowledge about facial morphea and the extent to which they perceived themselves as different from others. Self-perceptions were based on the visibility of the lesion, different phases of life transitions and reactions of others, (e.g. intrusive questioning and bullying). Medication routines and side effects, such as weight gain added to participants' stress. To manage the impact of facial morphea, children and their parents used strategies to normalize the experience by hiding physical signs of the illness, constructing explanations about what 'it' is, and by connecting with their peers.
Conclusion
Understanding what it is like to live with facial morphea from the perspectives of children and parents is important for devising ways to support children with facial morphea to achieve a better quality of life. Health care providers can help families access resources to manage anxiety, deal with bullying and construct adequate explanations of facial morphea, as well as providing opportunities for peer support.
This article is protected by copyright. All rights reserved.
http://ift.tt/2CpLLvq
Aquagenic Wrinkling of the Palms in Patients with Cystic Fibrosis
Abstract
Aquagenic wrinkling of the palms (AWP) is a condition characterized by oedema, confluent white papules and excessive wrinkling of the palms after few minutes exposure to water. The phenomenon may be associated with pain, numbness and pruritus1,2. It was first noticed and described in 1974 in children with cystic fibrosis (CF) by a paediatrician R.B. Elliott3.
This article is protected by copyright. All rights reserved.
http://ift.tt/2Eyn5qE
“It's a traumatic illness, traumatic to witness.” A qualitative study of the experiences of bereaved family caregivers of patients with cutaneous T-cell lymphoma
Abstract
Background
Cutaneous T-cell lymphomas (CTCL) are rare cancers which can be difficult to diagnose, are incurable and adversely affect quality of life, particularly in advanced disease. Families often provide care, but little is known about their experiences or needs while caring for their relative with advanced disease or in bereavement.
Objectives
To explore the experiences of bereaved family caregivers of patients with CTCL.
Methods
Single semi-structured qualitative interviews were conducted with bereaved family caregivers of patients with CTCL recruited via a supra-regional CTCL clinic. Transcribed interviews were analysed thematically, focusing on advanced disease, the approach of death and bereavement.
Results
Fifteen carers of eleven deceased patients participated. Experiences clustered under four themes
1 Complexity of care and medical intervention
2 Carer roles in advanced CTCL
3 Person vs. organisation-centred care in advanced CTCL
4 Knowing and not knowing: reflections on dying, death and bereavement
Caregivers often had vivid recollections of the challenges of caring for their relative with advanced CTCL and some took on quasi-professional roles as a result. Advanced disease made high demands on both organisational flexibility and family resources. For many caregivers, seeing disease progression was a prolonged and profoundly traumatic experience. The extent to which they were prepared for their relative's death and supported in bereavement was highly variable.
Subthemes within each theme provide more detail about caregiver experiences.
Conclusions
Family caregivers should be considered part of the wider healthcare team, acknowledging their multiple roles and the challenges they encounter in looking after their relative with CTCL as the disease progresses. Their experiences highlight the importance of organisational flexibility and of good communication between health care providers in advanced CTCL.
This article is protected by copyright. All rights reserved.
http://ift.tt/2CpLE2Y
Developing competent videofluoroscopic swallowing study analysts
Purpose of review This review examines the recent literature concerning the development of VFSS analysts. Recent findings Face-to-face and blended methods of training improve reliability and accuracy of VFSS analysis. However, with the exception of the literature describing the MBSImP training, most studies investigate relatively brief training for specific VFSS rating tools. The influence of training mode and trainee factors has received limited attention. Summary There is a lack of controlled studies investigating the influences of training methods for VFSS analysis. Pilot data is emerging concerning VFSS analysis training 'packages' but without information about the relative influence of training mode, it is difficult to determine the most efficient and cost-effective way of training VFSS analysts. Future research should investigate the contribution of trainee-related factors to succeed in VFSS analysis training, and the relative benefits and disadvantages of online, peer, independent, and blended modes of training. Correspondence to Ann Edwards, School of Allied Health, Australian Catholic University, Room 203.2.05, 1100 Nudgee Rd, PO Box 456, Banyo, QLD 4014, Australia. Tel: +61 7 3861 6091; e-mail: ann.edwards@acu.edu.au Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2EvPZ6O
http://ift.tt/2EvPZ6O
The Validity of the Diagnostic Code for Pyoderma Gangrenosum in an Electronic Database
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory and ulcerative neutrophilic dermatosis with an estimated incidence of 3-10 cases per million people annually.1Given that our understanding of PG is limited by disease rarity and considerable misdiagnosis rates (~30-50%),2 establishing a method to identify cases in large databases would facilitate population-based research. This approach has been used in other dermatologic diseases,3–6 where case identification is performed by diagnosis-related queries based on the International Classification of Diseases (ICD) code.
This article is protected by copyright. All rights reserved.
http://ift.tt/2EwIHno
Effects of Sedentary Aging and Lifelong Exercise on Left Ventricular Systolic Function
ABSTRACTPurposeThe current study examined whether age-related changes in left ventricular (LV) longitudinal systolic function is an adaptation to a more sedentary lifestyle and can be preserved by lifelong exercise training.MethodsA cross-sectional examination of 18 sedentary young (37 ± 6 yr), 29 sedentary seniors (71 ± 5 yr, 0–3 exercise sessions per week), and 26 seniors (68 ± 5 yr) who had performed a committed level (four to seven exercise sessions per week) of lifelong (>25 yr) exercise. Invasive right heart catheterization (pulmonary capillary wedge pressure) and noninvasive measures of LV function were collected at the following conditions: 1) supine rest, 2) during LV unloading (lower body negative pressure), and 3) LV loading (saline infusion). Ejection fraction and preload-recruitable stroke work (PRSW) were used to describe global LV systolic function, while peak systolic tissue velocity and longitudinal strain (LS) indicate LV longitudinal systolic function. To adjust LS for aging and training-related differences in LV preload and afterload, LV end-diastolic volume and end-systolic pressure (ESP) were included as covariates in ANCOVA models.ResultsEjection fraction and PRSW were unaffected by aging or lifelong exercise (P = 0.22, P = 0.08, respectively). Peak systolic tissue velocities decreased with aging (P 25 yr) exercise. Invasive right heart catheterization (pulmonary capillary wedge pressure) and noninvasive measures of LV function were collected at the following conditions: 1) supine rest, 2) during LV unloading (lower body negative pressure), and 3) LV loading (saline infusion). Ejection fraction and preload-recruitable stroke work (PRSW) were used to describe global LV systolic function, while peak systolic tissue velocity and longitudinal strain (LS) indicate LV longitudinal systolic function. To adjust LS for aging and training-related differences in LV preload and afterload, LV end-diastolic volume and end-systolic pressure (ESP) were included as covariates in ANCOVA models. Results Ejection fraction and PRSW were unaffected by aging or lifelong exercise (P = 0.22, P = 0.08, respectively). Peak systolic tissue velocities decreased with aging (Phttp://ift.tt/2C2Q0By
Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases
ABSTRACTPurposeThe presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases.MethodsBetween 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg·m−2) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention.ResultsThere was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4–6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6–12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507).ConclusionsMultimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain.Trial Registration: ACTRN12611001158954. Purpose The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases. Methods Between 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg·m−2) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention. Results There was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4–6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6–12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507). Conclusions Multimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain. Trial Registration: ACTRN12611001158954.http://ift.tt/2EynGJ4
Εγγραφή σε:
Αναρτήσεις (Atom)