Incidence of simultaneous renal cyst with calyceal diverticula in contralateral kidney is rare in children. A minimally invasive procedure in different sittings is often recommended.
https://ift.tt/2NUSecs
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Δευτέρα 1 Οκτωβρίου 2018
Robotic renal cyst decortication with calyceal diverticulectomy in a toddler – technical practicalities: a case report
Correction to: Neural therapy of an athlete’s chronic plantar fasciitis: a case report and review of the literature
In the publication of this article [1], there are reference errors in four positions the respective references are missing since reference Fischer [26] was omitted.
https://ift.tt/2y6UPWb
Why Shouldn’t We Forget About the Role of Clinical Psychologists in the Treatment of Patients with Psoriasis?
Epidermal Nevi and Related Syndromes — Part 1: Keratinocytic Nevi
Epidermal Nevi and Related Syndromes —Part 2: Nevi Derived from Adnexal Structures
Cutaneous Adverse Drug Reactions: How to Identify the Trigger
The Library of the Spanish Academy of Dermatology and Venereology (AEDV)
Functional Surgery for Malignant Subungual Tumors: A Case Series and Literature Review
Systemic Treatment of Moderate to Severe Psoriasis in Pediatric Patients in Galicia, Spain: A Descriptive Study
A. Batalla, R. Fernández-Torres, L. Rodríguez-Pazos, B. Monteagudo, R. Pardavila-Riveiro, R. Rodríguez-Lojo, Á. Zulaica, M. Cabanillas, E. Fonseca, Á. León, L. Fernández-Díaz, T. Abalde, L. Salgado-Boquete, F. Valdés, M.J. Seoane-Pose, H. Vázquez-Veiga, I. Suárez-Conde, J. Álvarez-López, Á. Flórez
Actas Dermosifiliogr.2018;109:722-32
Abstract - Full Text - PDF
https://ift.tt/2NXg879
Measurement of the Psychological Impact of Psoriasis on Patients Receiving Systemic Treatment
Blisters Induced by PUVA: A Report of 5 Cases
Diffuse Erythema and Acral Hyperkeratosis in a Newborn
Multiple Acquired Hypopigmented Nodules on the Anterior Chest
Panniculitis Due to Atypical Mycobacteria After Mesotherapy
Inflammation of Actinic Keratosis During Panitumumab Therapy
Antimicrobial susceptibility of 260 Clostridium botulinum types A, B, Ba and Bf strains and a neurotoxigenic Clostridium baratii type F strain isolated from California infant botulism patients [Susceptibility]
Infant botulism is an infectious intestinal toxemia that results from colonization of the infant large bowel by Clostridium botulinum (or rarely, by neurotoxigenic C. baratii or C. butyricum), with subsequent intraintestinal production and absorption of botulinum neurotoxin that then produces flaccid paralysis. The disease is often initially misdiagnosed as suspected sepsis or meningitis, diagnoses that require prompt empiric antimicrobial therapy. Antibiotics may also be needed to treat infectious complications of infant botulism, such as pneumonia or urinary tract infection. Clinical evidence suggests (see included case report) that broad-spectrum antibiotics that are eliminated by biliary excretion may cause progression of the patient's paralysis by lysing C. botulinum vegetative cells in the large bowel lumen and thereby increasing the amount of botulinum neurotoxin available for absorption. The purpose of this antimicrobial susceptibility study was to identify an antimicrobial agent with little or no activity against C. botulinum that could be used to treat infant botulism patients initially diagnosed with suspected sepsis or meningitis, or who acquired secondary infections, without lysing C. botulinum. Testing of 12 antimicrobial agents indicated that almost all California infant botulism patient isolates are susceptible to most clinically utilized antibiotics and are also susceptible to newer antibiotics not previously tested against large numbers of C. botulinum patient isolates. No antibiotic with little or no activity against C. botulinum was identified. These findings reinforce the importance of promptly treating infant botulism patients with Human Botulism Immune Globulin (BIG-IV; BabyBIG®).
https://ift.tt/2xSrbEN
A simple alternative sampling method for benznidazole pharmacokinetic assessment: a dried blood spot technique-based LC-MS/MS method [Analytical Procedures]
Chagas Disease (CD) is recognized as one of the major global neglected tropical diseases. Benznidazole (BNZ) is the drug of choice for the treatment of adults, young infants, and newborns with CD. However, the pharmacokinetics (PK) of BNZ has been poorly evaluated in all age groups, with consequent gaps in knowledge about PK-PD relationships in CD. The purpose this study was to develop and validate a bioanalytical method to quantify BNZ levels in small volume whole blood samples collected as dried blood spots (DBS). The analysis was performed using high performance liquid chromatography positive electrospray tandem mass spectrometry. PK evaluation in healthy male volunteers was conducted to verify the correlation between DBS and plasma BNZ concentrations. The calibration curve was linear from 50 to 20,000 ng.mL–1. Intra- and inter-day precisions and biases were less than 14.87% (n = 9) and 9.81% (n = 27), respectively. The recovery rates ranged from 94 to 100% and no matrix effect. There was no haematocrit level effect in a range of 20 to 70%. The PK results obtained from DBS and plasma were comparable (r2 = 0.8295) and equivalent to previously published information on BNZ. BNZ in DBS was stable at room temperature for over one year. This article describes the first micro-sampling method for measuring BNZ levels in DBS that has the potential to facilitate broad implementation of PK in clinical trials involving adult and paediatric patients in remote endemic areas and help to address existing knowledge gaps in the treatment in CD.
https://ift.tt/2DUIPgm
A Phase 1 Study to Assess the Pharmacokinetics of Intravenous Plazomicin in Adult Subjects with Varying Degrees of Renal Function [Clinical Therapeutics]
Plazomicin is an FDA-approved aminoglycoside for the treatment of complicated urinary tract infection. In this open-label study, 24 adults with normal renal function or mild, moderate, or severe renal impairment (n = 6 per group) received a single dose of plazomicin 7.5 mg/kg as a 30-min intravenous infusion. Total clearance declined with renal impairment, resulting in 1.98-fold and 4.42-fold higher plazomicin AUC0– values in subjects with moderate and severe impairment, respectively, relative to normal renal function.
https://ift.tt/2xSrb7L
Tenofovir exposure during pregnancy and postpartum in women receiving tenofovir disoproxil fumarate for the prevention of mother-to-child transmission of hepatitis B virus [Pharmacology]
We assessed tenofovir exposure during pregnancy and postpartum in hepatitis B virus (HBV)-infected, HIV-uninfected, women receiving tenofovir disoproxil fumarate (TDF) to prevent mother-to-child transmission of HBV. Data from 154 women who received TDF within a randomized-controlled trial were included. Individual plasma tenofovir exposures (AUC0-24) were estimated using a population pharmacokinetic approach. Estimated geometric mean tenofovir AUC0-24 was 20% (95% CI: 19-21%) lower during pregnancy compared to postpartum; this modest reduction in the absence of HBV transmission suggests no dose adjustment is needed.
https://ift.tt/2DUID0C
Tri-chlorination of a teicoplanin type glycopeptide antibiotic by the halogenase StaI evades resistance [Mechanisms of Resistance]
Glycopeptide antibiotics (GPAs) include clinically important drugs used for the treatment of infections caused by Gram positive pathogens. These antibiotics are specialized metabolites produced by several genera of actinomycetes bacteria. While many GPAs are highly chemically modified, A47934 is a relatively unadorned GPA lacking sugar or acyl modifications, common to other members of the class, but which is chlorinated at three distinct sites. The biosynthesis of A47934 is encoded by a 68 kb gene cluster in Streptomyces toyocaensis NRRL 15009. The cluster includes all the necessary genes for the synthesis of A47934 including two predicted halogenase genes, staI and staK. In this study, we report that only one of the halogenase genes, staI, is necessary and essential for A47934 biosynthesis. Chlorination of the A47934 scaffold is important for antibiotic activity as assessed by binding affinity for the target N-acyl-D-Ala-D-Ala. Surprisingly, chlorination is also vital to avoid activation of enterococcal and Streptomyces VanB-type GPA resistance through induction of resistance genes. Phenotypic assays showed stronger induction of GPA resistance by the dechlorinated compared to the chlorinated GPA. Correspondingly, the relative expression of enterococcal vanA resistance gene was shown to be increased by the dechlorinated compared to the chlorinated compound. These results provide insight into the biosynthesis of GPAs and the biological function of GPA chlorination for this medically important class of antibiotic.
https://ift.tt/2xSflKE
A high rate of ceftobiprole resistance among clinical MRSA from a hospital in central Italy [Mechanisms of Resistance]
Ceftobiprole is a fifth-generation cephalosporin with activity against MRSA. One-year surveillance at the Regional Hospital of Ancona (Italy) disclosed a 12% ceftobiprole resistance rate (12/102 isolates, MIC ≥4 mg/L). Epidemiological characterization demonstrated that the resistant isolates all belonged to different clones. PBP analysis showed substitutions in all PBPs and a novel insertion in PBP2a. Genes mecB and mecC were not detected. Ceftobiprole susceptibility screening is essential to avoid therapeutic failure and spread of ceftobiprole-resistant strains.
https://ift.tt/2DO1iLH
Pharmacokinetics of Intravenous Isavuconazole in Solid Organ Transplant Recipients [Clinical Therapeutics]
Isavuconazole may be useful in treating and preventing fungal infections in solid organ transplant (SOT) recipients due to its safety profile and activity against Aspergillus and some Mucorales. Isavuconazole has favourable pharmacokinetics based on clinical trials in various patient populations, but data are limited in SOT recipients. We evaluated the steady state pharmacokinetics of Isavuconazole in 26 SOT recipients receiving the drug intravenously for prophylaxis. There was moderate inter-patient variability in isavuconazole pharmacokinetic parameters (coefficients of variation of 51% for area under the plasma concentration-time curve (AUC) and 59% for trough plasma concentration), which were in general less than previously reported for other mould-active azoles such as voriconazole and posaconazole. AUC and steady state trough plasma concentrations (Ctrough) were significantly lower in women, patients with body mass index ≥18.5 kg/m2, and those receiving hemodialysis. Trough plasma concentrations were highly-correlated with AUCs (R2=0.94), and can serve as suitable measure of isavuconazole exposure in patients. In conclusion, moderate inter-patient variability in isavuconazole exposure, identification of factors associated with lower exposure, recognition that Ctrough is a surrogate marker for AUC and availability of a simple analytical method, suggest that therapeutic drug monitoring (TDM) may be useful for guiding treatment in at least some SOT recipients. Future studies are needed to correlate isavuconazole exposure with patients' clinical outcomes, and to determine the clinical role of TDM.
https://ift.tt/2xUyprI
Pentoxifylline alone or in combination with gentamicin or vancomycin inhibits live microbe-induced pro-inflammatory cytokine production in human cord blood and cord blood monocytes in vitro [Biologic Response Modifiers]
Introduction: Neonatal sepsis and its accompanying inflammatory response contribute to substantial morbidity and mortality. Pentoxifylline (PTX), a phosphodiesterase inhibitor which suppresses transcription and production of pro-inflammatory cytokines, is a candidate adjunctive therapy for newborn sepsis. We hypothesized that PTX decreases live microbe-induced inflammatory cytokine production in newborn blood.
Methods: Cord blood was stimulated with live microorganisms commonly encountered in newborn sepsis (Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, or Candida albicans), and simultaneously treated with antimicrobial agents (gentamicin, vancomycin, or amphotericin B) and/or clinically relevant concentrations of PTX. Microbial colony counts were enumerated by plating, supernatant cytokines measured by multiplex assay, intracellular cytokines and signaling molecules by flow cytometry, and mRNA by qRT PCR.
Results: PTX inhibited concentration-dependent E. coli-, S. aureus-, S. epidermidis-, and C. albicans-induced TNF and E. coli-induced IL-1β production in whole blood, with greater suppression of pro-inflammatory cytokines in combination with antimicrobial agents. Likewise, PTX suppressed E. coli-induced monocytic TNF and IL-1β, whereby combined PTX and gentamicin led to significantly greater reduction of TNF and IL-1β. The anti-inflammatory effect of PTX on microbe-induced pro-inflammatory cytokine production was accompanied by inhibition of TNF mRNA expression, and was achieved without suppressing the production of the anti-inflammatory IL-10. Of note, microbial colony counts in newborn blood were not increased by PTX.
Conclusion: Our findings demonstrated that PTX inhibited microbe-induced pro-inflammatory cytokine production, especially when combined with antimicrobial agents, without enhancing microbial proliferation in human cord blood in vitro, thus supporting its utility as candidate adjunctive agent for newborn sepsis.
https://ift.tt/2DOgV5Y
Efficacious Analogs of the Lantibiotic Mutacin 1140 Against a Systemic MRSA Infection [Experimental Therapeutics]
Mutacin 1140, a member of the epidermin family of type AI lantibiotics, has a broad spectrum of activity against Gram-positive bacteria. It blocks cell wall synthesis by binding to lipid II. Although it has rapid bactericidal effects and potent activity against Gram-positive pathogens, its rapid clearance and short half-life in vivo limits its development in clinic. In this study, we evaluated the effect of charged and dehydrated residues on the pharmacokinetics of mutacin 1140. The dehydrated residues were determined to contribute to the stability of mutacin 1140, while alanine substitutions of the lysine or arginine residues improved the pharmacological properties of the antibiotic. Analogs K2A and R13A had a significantly lower clearance, leading to higher plasma concentrations over time. They also had improved bioactivities against several pathogenic bacteria. In a murine systemic MRSA infection model, a 10 mg/kg single intravenous bolus injection of the K2A and R13A analogs (1:1 ratio) protected 100% of infected mice, while a 2.5 mg/kg dose resulted in 50% survival. The 10 mg/kg treatment group had a significant reduction in bacteria load in the liver and kidney, compared to the vehicle control group. The study provides lead compounds for future development of antibiotics used to treat systemic Gram-positive infections.
https://ift.tt/2xZSLQH
Nitazoxanide: A Therapeutic Option for Adenovirus Related Enteritis in Immunocompromised Adults [Letters]
Clinical efficacy of cidofovir for treatment of adenovirus-related disease is limited and toxicity is a major concern....
https://ift.tt/2DUI4Uy
Correlation of invitro susceptibility based on MICs and SQLE mutations with clinical response to terbinafine in patients with tinea corporis/cruris [Clinical Therapeutics]
Recalcitrant dermatophytoses are on the rise in India. High MICs of terbinafine (TRB) and squalene epoxidase (SQLE) mutations conferring resistance in Trichophyton spp have been recently documented. However, studies correlating laboratory data with clinical response to TRB in tinea corporis/cruris are lacking. This study investigated the clinico-mycological profile of 85 tinea corporis/cruris patients, and performed antifungal susceptibility testing by CLSI micro-broth dilution and SQLE mutation analysis of isolates obtained and correlated these with the response to TRB. Cases confirmed by KOH mount of skin scrapings were started on TRB 250 mg once a day (OD). If >50% clinical clearance was achieved by 3 weeks, the same dose was continued (Group 1). If response was <50%, the dose was increased to 250 mg twice a day (BD) (Group 2). If the response still remained below 50% after 3 weeks of BD, the patients were treated with itraconazole (ITR; Group 3). Overall, 64 patients' (75.3%) skin scrapings yielded growth on culture. Strikingly all isolates were confirmed as Trichophyton interdigitale by ITS sequencing. Thirty-nine (61%) isolates had TRB MICs ≥1 µg/ml. Complete follow-up data was available for 30 culture positive patients. A highly significant difference in modal MICs to TRB among the three treatment response groups was noted (p=0.009).Interestingly, 8 of the 9 patients in group 3 harboured isolates exhibiting elevated TRB MICs (8-32µg/ml) and SQLE mutations. The odds of achieving cure with TRB MIC<1 µg/ml strains were 2.5 times the odds of achieving cure with the strain exhibiting MIC ≥1 µg/ml.
https://ift.tt/2xQsDav
Selective inhibition of Neisseria gonorrhoeae by a dithiazoline in mixed infections with Lactobacillus gasseri [Experimental Therapeutics]
The Gram-negative human pathogen Neisseria gonorrhoeae has progressively developed resistance to antibiotic monotherapies, and recent failures of dual-drug therapy have heightened concerns that strains resistant to all available antibiotics will begin circulating globally. Targeting bacterial cell wall assembly has historically been effective at treating infections with N. gonorrhoeae, but as the effectiveness of β-lactams (including cephalosporins) are challenged by increasing resistance, research has expanded into compounds that target the numerous other enzymes with roles in peptidoglycan metabolism. One example is the dithiazoline compound JNJ-853346 (DTZ), which inhibits the activity of an E. coli serine protease L,D-carboxypeptidase (LdcA). Recently, the characterization of an LdcA homolog in N. gonorrhoeae revealed localization and activity differences from the characterized E. coli LdcA, prompting us to explore the effectiveness of DTZ against N. gonorrhoeae. We found that DTZ is effective at inhibiting N. gonorrhoeae in all growth phases, unlike the specific stationary-phase inhibition seen in E. coli. Surprisingly, DTZ does not inhibit gonococcal LdcA enzyme activity, nor is DTZ sensitivity significantly decreased in ldcA mutants. While effective against numerous N. gonorrhoeae strains, including recent multi-drug resistant isolates, DTZ is much less effective at inhibiting growth of the commensal species Lactobacillus gasseri. DTZ treatment during co-infections of epithelial cells resulted in significant lowering of gonococcal burden and IL-8 secretion without significantly impacting recovery of viable L. gasseri. This selective toxicity presents a possible pathway for the use of DTZ as an effective anti-gonococcal agent at concentrations that do not impact vaginal commensals.
https://ift.tt/2DUHR3I
Emergence and within-host genetic evolution of methicillin-resistant Staphylococcus aureus resistant to linezolid in a cystic fibrosis patient [Mechanisms of Resistance]
Methicillin resistant Staphylococcus aureus (MRSA) infection has increased in recent years among cystic fibrosis (CF) patients. Linezolid (LZD) is one of the anti staphylococci antibiotic widely used in this context. Although LZD resistance is rare, it has been described as often associated with long term treatments. Thirteen MRSA strains isolated over 5 years from one CF patient were studied for LZD resistance emergence and underwent whole genome sequencing (WGS). Resistance emerged after three 15 day LZD therapeutic regimens over 4 months. It was associated with the G2576T mutation in all the 5 rrl copies along with a very high MIC (>256mg/L) and a strong increase of the generation time. Resistant strains isolated during the ensuing LZD therapeutic regimens and until 13 months after LZD stopped, harbored only 3 or 4 rrl mutated copies, associated with lower MICs (8 to 32mg/L) and low to moderate generation time increase. Despite these differences, whole genome sequencing allowed us to determine that all isolates, including the susceptible one isolated before LZD treatment, belonged to the same lineage. In conclusion, LZD resistance can emerge rapidly in CF patients and persist without linezolid selective pressure in MRSA colonizing strains belonging to the same lineage.
https://ift.tt/2xOcNxe
Emergence of Klebsiella pneumoniae harboring the aac(6')-Ian amikacin resistance gene [Letters]
Carbapenemase-producing Enterobacteriaceae (CPE) have become a major public health concern worldwide (1)....
https://ift.tt/2DKGFju
Effects of Radioactive Iodine Therapy on Ovarian Reserve: A Prospective Pilot Study
Thyroid, Ahead of Print.
https://ift.tt/2DMntlt
Surgical treatments for a case of superior canal dehiscence syndrome associated with patulous Eustachian tube
The patulous Eustachian tube (PET) and superior semicircular canal dehiscence syndrome (SCDS) have similarity in their symptoms and similar effects caused by positional changes, causing difficulty in the differentiation between the two disorders. This report describes a case of both SCDS and PET that was eventually successfully treated.
https://ift.tt/2QmCKe8
Simultaneous bilateral butterfly tympanoplasty using tragal cartilage from one ear
To evaluate the outcomes of simultaneous bilateral inlay butterfly cartilage tympanoplasties (BIBCT) using tragal cartilage from one ear in patients with bilateral chronic otitis media (BCOM).
https://ift.tt/2NYYC2A
Thyroid Nodules and Goiters Presentations at American Thyroid Association: 88th Annual Meeting
October 2, 2018—The American Thyroid Association (ATA) will hold its 88th Annual Meeting on October 3‒7, 2018, at the Marriott Marquis in Washington, DC. In addition to the major speeches and awards, a variety of smaller presentations will be accessible to attendees in the form of posters and oral abstracts. One group of these regards thyroid nodules and goiters.
- Dr. Trevor Engell of the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women's Hospital and Harvard Medical School, in Boston, Massachusetts, will present a study called "Xpression Atlas Findings in the Genomic Sequencing Classifier (GSC) Clinical Validation Cohort."
The GSC used in this study classifies cytologically indeterminate thyroid nodules as either benign (B) or suspicious (S). The ability to detect genomic variants and fusions was recently expanded by the Xpression Atlas (XA), which identifies 761 nucleotide variants and 130 fusion gene pairs in 511 genes. In this study, researchers used XA to analyze the mutational spectrum of 190 nodules classified with standard histologic diagnoses (using microscopic studies of the tissues) as belonging to categories III and IV in the Bethesda System for Reporting Thyroid Cytopathology (BSRTC). The conclusion was that GSC is better than XA for ruling out cancers, while the two used together may provide additional insights into pathway activation and potential cancer treatment targets.
Another study involving XA will be presented by Dr. Allan C. Golding of the Memorial Center for Integrative Endocrine Surgery in Hollywood, Florida. Titled "Xpression Atlas Variants and Fusions Found Among 4,742 Thyroid Nodules," the study involved reanalyzing all clinical samples with complete XA profiles from July 2017 to April 3, 2018.
Overall, fusions were detected less frequently than variants across all BSRTC categories. This analysis supported excluding XA reporting among GSC-benign nodules. However, markedly different genomic insights were found between cohorts at increased risk of cancer, specifically, those in categories III through VI of the BSRTC. Together, the GSC and XA contribute substantial genomic content to advance preoperative risk stratification.
In a presentation by Dr. Christine Cherella of Boston Children's Hospital (BCH), attendees will learn how "Malignancy Rates of Thyroid Nodules Differ Between Children and Adults Within Indeterminate Cytopathological Categories." Thyroid nodules are more common in older individuals but are more likely to be malignant in younger ones. Although the BSRTC is widely used to interpret fine-needle aspiration (FNA) cytology, it is unclear whether BSRTC diagnostic categories suggest the same risk of malignancy in younger versus older patients.
Researchers evaluated all consecutive patients who underwent FNA of a thyroid nodule ≥1 cm in diameter, at the BCH and the Brigham and Women's Hospital between 1998 and 2016. They found that, in children and adults with clinically relevant thyroid nodules, malignancy rates differ within indeterminate BSRTC categories defined by similar morphologic features. This finding likely reflects true differences in nodule biology rather than variations in cytological classification.
Dr. Yu-kun Luo of the Ultrasound Department, General Hospital of Chinese PLA, Beijing, China, will present a study titled "Artificial Intelligence-Assisted Ultrasound Diagnosis for Thyroid Nodules." Due to uneven development of medical resources, diagnostic accuracy for thyroid nodules varies greatly. The aim of this study was to explore a novel AI-assisted ultrasound diagnostic system to improve the efficiency and accuracy of thyroid nodule diagnosis.
To test the accuracy of the new system, 500 pathologically confirmed thyroid nodules were selected, including 208 benign and 292 malignant ones. The images of all nodules, acquired from 10 different types of ultrasound equipment, were dynamically stored in the form of consecutively longitudinal and transverse sections. The AI-assisted diagnostic system recognized and analyzed the features of the images and offered recommendations for diagnosis. The diagnostic accuracy of the system was then compared with that of junior and senior physicians. Results showed the diagnostic accuracy of the AI system alone was higher than that of junior physicians (77.6% vs. 70.5%); however, accuracy could reach 92.4% when junior physicians were assisted by the new AI system—higher than the accuracy of senior physicians (85.6%) unassisted by the system. For nodules of different sizes, testing showed no significant difference in diagnostic accuracy among the three groups.
Another presentation will be given by Dr. Mingbo Zhang of the same department in Beijing's General Hospital. Dr. Mingbo will describe a "Randomized controlled clinical trial of ethanol-sensitized radiofrequency ablation (RFA) for benign solid thyroid nodules" that took place between June 2016 and February 2018. While solid thyroid nodules are good candidates for RFA surgery, they often require high power and energy, which increase the incidence of complications. This study used ethanol as a sensitizer before RFA to explore whether that could achieve a safer, faster, and more effective result.
Seventy-two patients with 84 nodules among them were enrolled in the study group and in a conventional RFA group, respectively, each with 42 nodules. The researchers concluded that ethanol can significantly improve the efficiency of RFA, reduce the time and energy of the ablation, and reduce the occurrence of complications.
In a presentation titled "Efficacy and Safety of Thermal Ablation of 200 Benign Thyroid Nodules: Comparison of Three Techniques (Radiofrequency, Laser, High Intensity Focused Ultrasound)," Dr. Adrien Ben Hamou of the Endocrinology Department at the University Hospital in Lille, France, will describe a bicentric retrospective study conducted between October 2013 and January 2018.
The aim was to compare the three ablation methods for treating benign thyroid nodules. Two hundred nodules were treated in 176 patients with benign histology or cytology, all of whom refused surgery. Clinical, biological, and ultrasound evaluation was performed before treatment. Researchers compared variations in volume and symptoms as well as side effects at 6 weeks and 12 months after treatment. Volume reduction between radiofrequency (RFA) and laser (LA) ablation was significantly different at 6 weeks but not at 12 months. After adjustments, no significant difference was observed at either 6 weeks or 12 months between RFA and high-intensity focused ultrasound (HIFU) or between LA and HIFU. Clinical symptoms were reduced in all three groups. Very few transient but potentially serious side effects were reported, the causes of which should be analyzed.
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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:
- The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
- Annual scientific meetings
- Biennial clinical and research symposia
- Research grant programs for young investigators
- Support of online professional, public, and patient educational programs
- Development of guidelines for clinical management of thyroid disease and thyroid cancer
The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).
The post Thyroid Nodules and Goiters Presentations at American Thyroid Association: 88th Annual Meeting appeared first on American Thyroid Association.
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Disorders of Thyroid Function Presentations at American Thyroid Association: 88th Annual Meeting
October 2, 2018—The American Thyroid Association (ATA) will hold its 88th Annual Meeting on October 3‒7, 2018, at the Marriott Marquis in Washington, DC. In addition to the major speeches and awards, a variety of smaller presentations will be accessible to attendees in the form of posters and oral abstracts. One group of these concerns disorders of thyroid function.
- Dr. Maia Banige will give a presentation titled "Prediction of fetal and neonatal dysthyroidism," showing how imperfect development and function of the thyroid in fetuses (FD) and newborns (ND) can be predicted from perinatal variables. Dr. Banige is from the Department of Pediatrics-Neonatology and Pediatric Emergency of the French-British Hospital Institute, Levallois-Perret, Ile-de-France.
She and her colleagues conducted a retrospective, multicenter study using data from the medical records of all patients monitored for pregnancy from 2007 to 2014 in 10 obstetric centers of the Assistance Publique des Hôpitaux de Paris. Women with Graves' disease who were positive for thyrotropin receptor antibodies (TRAb) at least once during pregnancy were included. Among 280,000 births, 2,288 medical records of women with thyroid dysfunction were selected and screened, and 417 women with Graves' disease who were positive for TRAb during pregnancy (0.15%) were finally included in the study.
Analysis revealed that the TRAb level in the mother and child was the strongest independent predictor of thyroid dysfunction. The risk of FD and ND increases with maternal hormonal imbalance and is also greater in the patients receiving antithyroid drugs (ATDs) during pregnancy. In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction.
A presentation titled "Pre-conception thyroid stimulating hormone level and risk of preterm birth in over 4.3 million rural Chinese women aged 20-49 years: a population-based cohort study" will be given by Dr. Ying Yang of the National Research Institute for Health and Family Planning and the National Human Genetic Resources Center. Dr. Ying and his colleagues studied the association between the pre-conception thyroid stimulating hormone (TSH) levels of women planning for pregnancy and the risk of preterm births (PTB).
Researchers conducted a historical cohort study of 4,320,584 rural reproductive-age women who had participated in free National Free Pre-pregnancy Checkups (NFPC) in 2013-2016 in China. Data on preconception TSH, history of pregnancy and diseases, and other variables were obtained from the physical examination record in NFPC. Successful conception and pregnancy outcomes were documented during the follow-up period, June 2013 to December 2017. PTB is defined as any birth within 28 to 37 weeks of gestational age. Participants who failed to become pregnant within 6 months, suffered from fetal death or stillbirth, or had multiple gestations during the period of study were excluded from the analysis. The data documented 283,854 PTB events (6.57%).
The study identified a V-shaped relationship between maternal pre-conception TSH levels and PTB risk. Either decreasing or increasing pre-conception TSH levels can significantly increase the risk of preterm birth.
Dr. George Kahaly of the Department of Medicine at Johannes Gutenberg University Medical Center in Mainz, Germany, and colleagues have undertaken a three-phase clinical trial of the drug teprotumumab. Results from the first phase—a 24-week randomized, double-masked, placebo-controlled treatment trial of the drug, which is an insulin-like growth-factor-1 receptor inhibitory antibody—were reported in the New England Journal of Medicine (NEJM 2017; 376:1748). Compared with a placebo (69% versus 20%), teprotumumab reduced protopsis (protrusion of the eyeballs) significantly beginning at week 6 and continuing over the 24 weeks of the trial. This second-phase report is an assessment of clinical status at weeks 28 and 72.
At week 28 (4 weeks after the treatment period), proptosis response was 73.8% in the teprotumumab group versus 13.3% in controls. At week 72 (48 weeks after treatment), 53% of week 24 teprotumumab proptosis responders maintained ≧ 2 mm improvement relative to baseline. Compared to baseline and placebo, clinical activity also decreased at week 28 and was relatively unchanged in the teprotumumab group at week 72. These results indicate no acute rebound of disease following the 24-week treatment.
Dr. Kahaly's group conclude that teprotumumab may represent a disease-modifying therapy in TAO by reducing proptosis and clinical activity, with sustained effects seen in most patients 48 weeks after treatment. In phase 3 of the trial, the research group will investigate whether patients would benefit from longer treatment or retreatment with teprotumumab.
Dr. Mats Holmberg of Institute of Medicine, Sahlgrenska Academy, and the Karolinska University Hospital, ANOVA, both in Stockholm, Sweden, will present a study titled "Structural brain changes in Graves' hyperthyroidism may be of autoimmune origin." During the hyperthyroid state of Graves' disease (GD), the volumes of medial temporal lobe (MTL) structures, e.g., the hippocampi, are reduced. This has been attributed to high thyroid hormone levels, but Dr. Holmberg and his colleagues hypothesized that the structural changes and mental symptoms may be due to autoimmunity per se. The aim of their study was to determine the relationship between nonthyroid autoimmunity and MTL volumes during hyperthyroidism in GD.
Dr. Holmberg's project is a longitudinal, observational, prospective case-controlled study in which 65 premenopausal women were evaluated within 2 weeks after a diagnosis of GD and again after 15 months of antithyroid treatment. Thyroid-stimulating hormone receptor antibodies, thyroid-stimulating immunoglobulins, and several additional antibodies were measured in the hyperthyroid state. MTL structures were scanned to determine hippocampal and amygdala volumes. This presentation reports preliminary data on the nonthyroid antibodies at baseline. Data on the thyroid antibodies will be reported separately.
The data so far support the hypothesis that autoimmunity that is not directly connected to the thyroid may be involved in the impairment of brain function in GD, introducing a new concept that needs further study.
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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:
- The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
- Annual scientific meetings
- Biennial clinical and research symposia
- Research grant programs for young investigators
- Support of online professional, public, and patient educational programs
- Development of guidelines for clinical management of thyroid disease and thyroid cancer
The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).
The post Disorders of Thyroid Function Presentations at American Thyroid Association: 88th Annual Meeting appeared first on American Thyroid Association.
https://ift.tt/2y42u7t
Clinical efficacy of sublingual immunotherapy is associated with restoration of steady-state serum lipocalin 2 after SLIT: a pilot study
So far, only a few biomarkers in allergen immunotherapy exist that are associated with a clinical benefit. We thus investigated in a pilot study whether innate molecules such as the molecule lipocalin-2 (LCN2)...
https://ift.tt/2y9uuqi
Patient Safety in Audiology
There is a need to educate audiologists, physicians, and other clinicians about patient safety in audiology. This article addresses the many aspects of patient safety and the applicability to the practice of audiology in health care. Clinical examples of strategies to build a culture of patient safety are provided.
https://ift.tt/2RjPELt
More than keratitis, ichthyosis, and deafness: multisystem effects of lethal GJB2 mutations
Infant death in KID syndrome is recognized; its association with specific genotypes and pathophysiology is inadequately understood.
https://ift.tt/2P4NVb4
Infertility and Teratogenicity after Paternal Exposure to Systemic Dermatologic Medications: A Systematic Review
Many systemic dermatologic medications can cause teratogenicity after maternal exposure. Some of these medications can cause infertility and may have teratogenic effects after paternal exposure; however, teratogenicity is understudied. Information on fertility effects or teratogenicity risk should guide discussions with male patients using these medications and looking to conceive.
https://ift.tt/2O0cEkF
Lower Socioeconomic Status is Associated with Delayed Access to Care for Infantile Hemangioma, a Cohort Study
What is already known on this topic: Children with Medicaid face greater barriers of access-to-care. Delayed management of complicated infantile hemangiomas compromises outcomes. What this article adds to our knowledge. Lower socioeconomic status is associated with delayed care for infantile hemangioma, but not among children with institutional care-management services. How this information impacts clinical practice and/or changes patient care. Institution-facilitated managed-care programs may moderate socioeconomic disparities in accessing timely specialty care and improve outcomes.
https://ift.tt/2NWRmEb
Overall and Subgroup Prevalence of Acne Vulgaris Among Patients with Hidradenitis Suppurativa
This analysis augments the significantly literature establishing the link between acne vulgaris and hidradenitis suppurativa. Understanding the burden of acne vulgaris among patients with hidradenitis suppurativa may support evaluation and optimization of management for both conditions.
https://ift.tt/2P10NPt
Association between atopic dermatitis and autoimmune disorders in US adults and children: A cross-sectional study
•The present study found increased risk of autoimmune disorders of the skin, endocrine, gastrointestinal, hematologic and musculoskeletal systems in both adults and children, with a predilection for females, young age, Asian race/ethnicity and those without asthma.•Clinicians should consider increased screening for autoimmune disorders in atopic dermatitis patients.
https://ift.tt/2NWRmUT
Cost Analysis of a Store and Forward Teledermatology Consult System in Philadelphia
When conducted appropriately, store and forward teledermatology can be cost saving by reducing unnecessary office-based dermatology clinic and emergency room visits. With engagement of stakeholders and proper planning, patients can obtain improved access to high-quality sustainable dermatologic care, in the setting of teledermatology reimbursement.
https://ift.tt/2NUQu2Z
Guideline-Based Medicine Grading based upon the Guidelines of Care for Ambulatory Atopic Dermatitis Treatment in the United States
Although atopic dermatitis practice guidelines are published, how doctors adhere to these guidelines is unknown. Using a grading system analogous to the United States A to F system, healthcare providers receive a grade of B or C in their atopic dermatitis management, suggesting that physicians may benefit from reviewing guidelines of care
https://ift.tt/2P0jYsN
A systematic review and meta-analysis of the regional and age-related differences of atopic dermatitis clinical characteristics
•This study identified considerable heterogeneity of atopic dermatitis, with seventy eight different signs and symptoms identified, and notable differences by study region and age-group.•These phenotypical differences should be incorporated into the diagnosis and severity assessment of atopic dermatitis patients.
https://ift.tt/2NUQmR3
"Treatment of male pattern alopecia with platelet-rich plasma: a double blind controlled study with analysis of platelet number and growth factor levels"
Platelet rich plasma (PRP) has shown promise for androgenetic alopecia. We found PRP injections significantly increased hair growth compared to placebo, but response was not correlated with platelet or the measured growth factors in PRP
https://ift.tt/2NVQGyR
Dr. Kimishige Ishizaka 1926-2018 The discovery of IgE and the revolution in the study of allergic disease
Dr. Ishizaka completed his medical qualifications and PhD at Tokyo University in 1948, and in 1953 he became head of the immune-serology division at the Japanese Institute of Health. In 1957-59 he spent two years at Cal Tech as a fellow with Dan Campbell (see Fig. 1) This period made a major impact on Kimi's subsequent career because Dr. Campbell already had an interest in both reagins and the source of allergens in house dust1, 2. In addition Kimi developed a further understanding of immunochemistry because Dan Campbell was one of the recognized authorities3.
https://ift.tt/2NWbeHG
Opioid Prescribing for Acute Postoperative Pain After Cutaneous Surgery
Nonopioid interventions should be used for patients in pain; patients who need opioids should also receive nonopioid therapy. Among patients requiring opioids, 36-hour supply is generally adequate. Requests for refill beyond expected duration of need should require return visit.
https://ift.tt/2P10LqP
Concordance of skin prick test and serum specific-IgE to locally produced-component-resolved diagnostics for cockroach allergy
Cockroaches (CR) are ubiquitous insects of public health concern as they are not only a potential source of pathogens, but also produce potent allergens that are hazardous to human health. It has been estimated that there are 4,000 extant species of CR. Whereas most species dwell in tropical and subtropical forests, about 50 species have adapted to life as domiciliary pests within the human environment.1 In Thailand, the American cockroach Periplaneta americana is predominant species.2 Exposure to cockroach (CR) allergens represents a high risk for IgE sensitization3,4 and allergic symptoms, particularly allergic rhinitis and atopic asthma after allergen reexposure.
https://ift.tt/2DK2Jeg
The role of TERT promoter mutations in differentiating recurrent nevi from recurrent melanomas: a retrospective, case-control study
Repigmentation at previous biopsy sites pose a significant diagnostic dilemma given clinical and histologic similarities between recurrent nevi and locally recurrent melanoma. While common in melanoma, the role of TERT promoter mutations (TPMs) in recurrent nevi is unknown.
https://ift.tt/2P4cq8e
Thyroid Cancer Presentations at American Thyroid Association: 88th Annual Meeting
October 2, 2018—The American Thyroid Association (ATA) will hold its 88th Annual Meeting on October 3‒7, 2018, at the Marriott Marquis in Washington, DC. In addition to the major speeches and awards, a variety of smaller presentations will be accessible to attendees in the form of posters and oral abstracts. One group of these regards thyroid cancer.
- Dr. Marcia Brose of the Department of Otorhinolaryngology at the Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, will present a study on the "Activity of Larotrectinib in Patients With Advanced TRK Fusion Thyroid Cancer." Tropomyosin receptor kinases (TRKs) are encoded by neurotrophic tyrosine receptor kinase (NTRK) genes. Fusion proteins involving NTRK genes are oncogenic and have been reported in a wide variety of malignancies, including nonmedullary thyroid cancer.
Larotrectinib is a potent and highly selective oral TRK inhibitor. The researchers studied the activity and safety of larotrectinib, using seven patients who had undergone thyroidectomies but were diagnosed with advanced TRK-fusion thyroid cancer.Larotrectinib is highly active and was very well tolerated, with treatment-related adverse events being predominantly grade 1. All patients continued to receive larotrectinib treatment after the end of the study. These results strongly support the inclusion of NTRK gene fusions as part of routine molecular testing for patients with advanced thyroid cancer. - Dr. Gary Clayman of the Thyroid and Parathyroid Institute of Tampa General Hospital in Florida will describe his group's analysis of 217 patients with thyroid nodules and lymph nodes of concern for malignancy. His presentation is titled "A National Epidemic of Inadequate Preoperative Neck Ultrasound in the Evaluation of Suspicious or Malignant Thyroid Nodules and Cervical Lymph Nodes." High-resolution ultrasound evaluation of the central and lateral neck is considered the gold standard in the evaluation of thyroid cancer. Dr. Clayman's group hypothesized that comprehensive ultrasound evaluation of the neck would be commonplace throughout the United States, because it is an accurate predictor of complete surgical resection and long-term, disease-free regional control.
The 217 consecutive patients all provided preoperative ultrasound CDs to the Institute, prior to having additional high-resolution ultrasound evaluation and management of their primary thyroid malignancy at a tertiary referral center during 2017. Information from the evaluation included sonographic status of the thyroid and central and lateral neck lymph nodes, demographics, histopathologic variables, and cancer staging. Of the 66 males and 151 females with a median age of 41 years (range 14-87), 68 (31%) of the previous ultrasound studies were from the southwest region and 149 (69%) from the rest of the United States. The images and reports revealed that only 4 (2%) of the previous ultrasound studies found any lateral neck lymph nodes. However, the high-resolution preoperative ultrasound carried out by Dr. Clayman's group found 101 patients (46%) with T1, 39 (18%) with T2, and 77 (35%) with T3 or T4 thyroid malignancies.
The researchers concluded that preoperative analysis of suspicious and malignant thyroid nodules is inadequate in imaging centers throughout the United States and likely contributes to persistent thyroid malignancy, increased health care costs, and patient morbidity. - In a study titled "Recombinant human thyrotropin [rhTSH] vs. thyroid hormone withdrawal [THW] in radioactive iodine therapy of thyroid cancer patients with nodal metastatic disease: Influence of prognostic factors on follow-up clinical status," Dr. David Taieb of the Nuclear Medicine Department at La Timone Hospital in Marseille, France, and colleagues asked whether patients with well-differentiated thyroid cancers (DTC) would respond differently to radioiodine therapy (RIT) when they were prepared with rhTSH, as opposed to those prepared with THW.While DTC has an excellent prognosis, patients' responses after thyroidectomy and RIT can be influenced by various factors, including age, number of nodes, location of nodes' invasion at diagnosis, and tumor stage. Researchers wanted to discover whether any of these factors effected the response to RIT. The 404 patients, with lymph node metastases and no evidence of distant metastasis at the time of RIT, were prepared with either rhTSH (205 patients) or THW (199). Patients and tumor characteristics were similar between the two groups for up to three years. None of the prognostic factors was found to be associated with different RIT outcomes after preparation with rhTSH versus THW.
###
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:
- The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
- Annual scientific meetings
- Biennial clinical and research symposia
- Research grant programs for young investigators
- Support of online professional, public, and patient educational programs
- Development of guidelines for clinical management of thyroid disease and thyroid cancer
The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).
The post Thyroid Cancer Presentations at American Thyroid Association: 88th Annual Meeting appeared first on American Thyroid Association.
https://ift.tt/2ReSxgp
A Survey On Fever Monitoring and Management in Patients With Acute Brain Injury: The SUMMA Study
Background: Fever is common in patients with acute brain injury and worsens secondary brain injury and clinical outcomes. Currently, there is a lack of consensus on the definition of fever and its management. The aims of the survey were to explore: (a) fever definitions, (b) thresholds to trigger temperature management, and (c) therapeutic strategies to control fever. Materials and Methods: A questionnaire (26 items) was made available to members of the European Society of Intensive Care Medicine via its website between July 2016 and December 2016. Results: Among 231 respondents, 193 provided complete responses to the questionnaire (84%); mostly intensivists (n=124, [54%]). Body temperature was most frequently measured using a bladder probe (n=93, [43%]). A large proportion of respondents considered fever as a body temperature >38.3°C (n=71, [33%]). The main thresholds for antipyretic therapy were 37.5°C (n=74, [34%]) and 38.0°C (n=86, [40%]); however, lower thresholds (37.0 to 37.5°C) were targeted in cases of intracranial hypertension and cerebral ischemia. Among first-line methods to treat fever, ice packs were the most frequently utilized physical method (n=90, [47%]), external nonautomated system was the most frequent utilized device (n=49, [25%]), and paracetamol was the most frequently utilized drug (n=135, [70%]). Among second-line methods, intravenous infusion of cold fluids was the most frequently utilized physical method (n=68, [35%]), external computerized automated system was the most frequently utilized device (n=75, [39%]), and diclofenac was the most frequently utilized drug (n=62, [32%]). Protocols for fever control and shivering management were available to 83 (43%) and 54 (28%) of respondents, respectively. Conclusions: In this survey we identified substantial variability in fever definition and application of temperature management in acute brain injury patients. These findings may be helpful in promoting educational interventions and in designing future studies on this topic. E.P. and F.S.T. were involved in the study design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision. M.O. was involved in study design, analysis and interpretation of data, drafting of manuscript, and critical revision. L.P. and R.H. were involved in study design, drafting of manuscript, and critical revision. F.S.T. is a lecturer for BARD. F.S.T. is the Chair of the Neuro-Intensive Care (NIC) section of the European Society of Intensive Care Medicine (ESICM). R.H. is a lecturer and received congress support from Bard and Zoll. R.H. is a steering committee member for the INTREPID study supported by Bard. L.P. is the Deputy Chair of the NIC section of the ESICM. The remaining authors have no funding or conflicts of interest to disclose. Address correspondence to: Edoardo Picetti, MD, Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy (e-mail: edoardopicetti@hotmail.com). Received March 9, 2018 Accepted August 16, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved
https://ift.tt/2OvhWDQ
https://ift.tt/2OvhWDQ
The Effect of Ultra–low-dose Intrathecal Naloxone on Pain Intensity After Lumbar Laminectomy With Spinal Fusion: A Randomized Controlled Trial
Background: Despite advances in pain management, several patients continue to experience severe acute pain after lumbar spine surgery. The aim of this study was to assess the safety and effectiveness of single ultra–low-dose intrathecal (IT) naloxone in combination with IT morphine for reducing pain intensity, pruritus, nausea, and vomiting in patients undergoing lumbar laminectomy with spinal fusion. Materials and Methods: In this double-blind trial, patients scheduled for lumbar laminectomy with spinal fusion were randomly assigned to receive single ultra–low-dose IT naloxone (20 μg) and IT morphine (0.2 mg) (group M+N) or IT morphine (0.2 mg) alone (group M). The severity of postoperative pain, pruritus and nausea, and frequency of vomiting were assessed at recovery from anesthesia and, subsequently, at 1, 3, 6, 12, and 24 hours postoperatively using an 11-point (0-10) visual analogue scale. Results: A total of 77 patients completed the study, and there were significant differences in postoperative pain, pruritus, and nausea visual analogue scale between the groups (P
https://ift.tt/2IrF3K6
https://ift.tt/2IrF3K6
Gastrointestinal juvenile-like (inflammatory/hyperplastic) mucosal polyps in neurofibromatosis type 1 with no concurrent genetic or clinical evidence of other syndromes
Abstract
Gastrointestinal "juvenile-like (inflammatory/hyperplastic) mucosal polyps" (JLIHMPs) have been proposed as a neurofibromatosis type 1 (NF1)-specific gastrointestinal manifestation. Juvenile polyposis syndrome (JPS) has also been reported in a NF1 patient, harboring concurrent NF1 and SMAD4 germline mutations. Additionally, NF1-like cafe-au-lait spots have been described in biallelic mismatch repair deficiency, another condition featuring gastrointestinal polyps. The SMAD4 and BMPR1A genes that are involved in 50–60% of JPS cases have not been investigated in the ~ 20 published cases of NF1-associated JLIHMPs with the exception of the abovementioned patient with concomitant JPS and NF1. NF1 defects have been found in the only two cases exhaustively tested. Therefore, JLIHMP has been questioned as an independent, NF1-specific entity. Incidental associations between NF1 and gastrointestinal polyposes at risk for gastrointestinal carcinoma should not be overlooked, given their implications in terms of clinical surveillance. We describe two patients featuring JLIHMPs in clinically/genetically proven NF1, in the absence of SMAD4 and BMPR1A mutations. In one case, the intervening mucosa was markedly inflamed, unlike JPS. We suggest that JLIHMP probably represents a gastrointestinal lesion specific to NF1.
https://ift.tt/2Ox17sw
Letter to the editor: Effect of changing postoperative pain management on bleeding rates in tonsillectomy patients
Publication date: Available online 30 September 2018
Source: American Journal of Otolaryngology
Author(s): Zhengcai Lou
https://ift.tt/2zINQVf
Female predisposition to TLR7-driven autoimmunity: gene dosage and the escape from X chromosome inactivation
Abstract
Women develop stronger immune responses than men, with positive effects on the resistance to viral or bacterial infections but magnifying also the susceptibility to autoimmune diseases like systemic lupus erythematosus (SLE). In SLE, the dosage of the endosomal Toll-like receptor 7 (TLR7) is crucial. Murine models have shown that TLR7 overexpression suffices to induce spontaneous lupus-like disease. Conversely, suppressing TLR7 in lupus-prone mice abolishes SLE development. TLR7 is encoded by a gene on the X chromosome gene, denoted TLR7 in humans and Tlr7 in the mouse, and expressed in plasmacytoid dendritic cells (pDC), monocytes/macrophages, and B cells. The receptor recognizes single-stranded RNA, and its engagement promotes B cell maturation and the production of pro-inflammatory cytokines and antibodies. In female mammals, each cell randomly inactivates one of its two X chromosomes to equalize gene dosage with XY males. However, 15 to 23% of X-linked human genes escape X chromosome inactivation so that both alleles can be expressed simultaneously. It has been hypothesized that biallelic expression of X-linked genes could occur in female immune cells, hence fostering harmful autoreactive and inflammatory responses. We review here the current knowledge of the role of TLR7 in SLE, and recent evidence demonstrating that TLR7 escapes from X chromosome inactivation in pDCs, monocytes, and B lymphocytes from women and Klinefelter syndrome men. Female B cells where TLR7 is thus biallelically expressed display higher TLR7-driven functional responses, connecting the presence of two X chromosomes with the enhanced immunity of women and their increased susceptibility to TLR7-dependent autoimmune syndromes.
https://ift.tt/2xRRT05
Sexual dimorphism in HIV-1 infection
Abstract
Sex-specific differences affecting various aspects of HIV-1 infection have been reported, including differences in susceptibility to infection, course of HIV-1 disease, and establishment of viral reservoirs. Once infected, initial plasma levels of HIV-1 viremia in women are lower compared to men while the rates of progression to AIDS are similar. Factors contributing to these sex differences are poorly understood, and range from anatomical differences and differential expression of sex hormones to differences in immune responses, the microbiome and socio-economic discrepancies, all of which may impact HIV-1 acquisition and disease progression. Ongoing research efforts aiming at controlling HIV-1 disease or reducing viral reservoirs need to take these sex-based differences in HIV-1 pathogenesis into account. In this review, we discuss established knowledge and recent findings on immune pathways leading to sex differences in HIV-1 disease manifestations, with focus on HIV-1 latency and the effect of female sex hormones on HIV-1.
https://ift.tt/2DJ3jbR
Sex-related factors in autoimmune liver diseases
Abstract
Autoimmune diseases are a broad range of diseases in which the immune system produces an inappropriate response to self-antigens. This results in inflammation, damage, or dysfunction of tissues and/or organs. Many autoimmune diseases are more common in women and differences between female and male immune and autoimmune responses have been well documented. In general, most of the autoimmune diseases seem to affect more females, although there are exceptions. Autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) are considered to be autoimmune liver diseases (AILD). They all are rare diseases and they result in significant morbidity and mortality. The female predominance in PBC and AIH are among the strongest among autoimmune diseases. However, the mechanisms responsible for the sex differences in autoimmune liver diseases are largely unknown. In this review, we discuss the recent findings on the influence of sex-dependent mechanisms, which may contribute to differences in presentation, clinical characteristics, disease course, and complications observed between female and male patients with autoimmune liver disease.
https://ift.tt/2xRRAlX
Objectively Measured Physical Activity, Sedentary Behavior, and Metabolic Syndrome in Adults: Systematic Review of Observational Evidence
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2IuhJeZ
Serum miRNA-based distinct clusters define three groups of breast cancer patients with different clinicopathological and immune characteristics
Abstract
Breast cancer (BCa) is a heterogeneous disease with different histological, prognostic and clinical aspects. Therefore, the need for identification of novel biomarkers for diagnosis, prognosis and monitoring of disease, as well as treatment outcome prediction remains at the forefront of research. The search for circulating elements, obtainable by simple peripheral blood withdrawal, which may serve as possible biomarkers, constitutes still a challenge. In the present study, we have evaluated the expression of 6 circulating miRNAs, (miR-16, miR-21, miR-23α, miR-146α, miR-155 and miR-181α), in operable BCa patients, with non-metastatic, invasive ductal carcinoma, not receiving neoadjuvant chemotherapy. These miRNAs, known to be involved in both tumor cell progression and immune pathways regulation, were analyzed in relation to circulating cytokines, tumor immune-cell infiltration and established prognostic clinicopathological characteristics. We have identified three different clusters, with overall low (C1), moderate (C2) or high (C3) expression levels of these six circulating miRNAs, which define three distinct groups of non-metastatic BCa patients characterized by different clinicopathological and immune-related characteristics, with possibly different clinical outcomes. Our data provide the proof-of-principle to support the notion that, up- or down-regulation of the same circulating miRNA may reflect different prognosis in BCa. Nonetheless, the prognostic and/or predictive potential of these three "signatures" needs to be further evaluated in larger cohorts of BCa patients with an, at least, 5-year clinical follow-up.
https://ift.tt/2NX03P2
Assessing the role of virtual reality training in Canadian Otolaryngology–Head & Neck Residency Programs: a national survey of program directors and residents
Given mounting pressure of work hour restrictions, resource constraints, and variability of clinical exposure, Otolaryngology–Head & Neck Surgery (OHNS) residency training has shifted away from the apprentices...
https://ift.tt/2DIaCRq
Assessing the role of virtual reality training in Canadian Otolaryngology–Head & Neck Residency Programs: a national survey of program directors and residents
Abstract
Background
Given mounting pressure of work hour restrictions, resource constraints, and variability of clinical exposure, Otolaryngology–Head & Neck Surgery (OHNS) residency training has shifted away from the apprenticeship model to embrace the Royal College of Physicians and Surgeons of Canada's "Competence by Design" initiative. As a result, appraising both current and potential educational adjuncts has become increasingly important. In this investigation, a national needs assessment survey was performed to identify strengths, weaknesses, and future opportunities of the current training landscape.
Methods
An online survey was distributed to all thirteen Canadian OHNS post-graduate administrators for completion by program directors and residents from February to October in 2016. Prior to distribution, the survey was vetted for face validity by a group of staff Otolaryngologists and questions were modified accordingly. Quantitative analysis was performed on SPSS (IBM Corp., Chicago) with non-parametric, two-tailed Mann-Whitney U testing performed on scaled questions.
Results
Of the 68 responses, 11 of 13 (84.6%) of program directors and 57 of 168 (33.9%) residents responded to the survey. All 13 programs currently utilize cadaveric laboratory dissections. Associated challenges were ranked as specimen availability, faculty participation, insufficient space, and resident time constraints. 30.8% of programs currently utilize some form of virtual reality simulator, which 90.9% of program directors felt would be a fair and effective platform for evaluation.
Conclusion
A discrepancy exists between the favourable attitudes of both residents and program directors towards virtual reality simulation and its actual adoption. For successful adoption to occur, the existing barriers to unconventional training must be addressed and the tangible benefits for competency based training will need to be explored.
https://ift.tt/2y74rzZ
Both rare and common species make unique contributions to functional diversity in an ecosystem unaffected by human activities
Chapman, ASA; Tunnicliffe, V; Bates, AE; (2018) Both rare and common species make unique contributions to functional diversity in an ecosystem unaffected by human activities. Diversity and Distributions , 24 (5) pp. 568-578. 10.1111/ddi.12712 . Green open access
https://ift.tt/2y1el6p
Variability of UK seagrass sediment carbon: Implications for blue carbon estimates and marine conservation management
Green, A; Chadwick, MA; Jones, PJS; (2018) Variability of UK seagrass sediment carbon: Implications for blue carbon estimates and marine conservation management. PLoS One , 13 (9) , Article e0204431. 10.1371/journal.pone.0204431 . Green open access
https://ift.tt/2OtscMW
Measuring narrative engagement: The heart tells the story
Richardson, D; Griffin, N; Zaki, L; Stephenson, A; Yan, J; Curry, T; Noble, R; ... Devlin, J; + view all Richardson, D; Griffin, N; Zaki, L; Stephenson, A; Yan, J; Curry, T; Noble, R; Hogan, J; Skipper, J; Devlin, J; - view fewer (2018) Measuring narrative engagement: The heart tells the story. BioRxiv: Cold Spring Harbor. Green open access
https://ift.tt/2xZp94M
Machine Learning Creates a Simple Endoscopic Classification System that Improves Dysplasia Detection in Barrett's Oesophagus amongst Non-expert Endoscopists
Sehgal, V; Rosenfeld, A; Graham, DG; Lipman, G; Bisschops, R; Ragunath, K; Rodriguez-Justo, M; ... Lovat, LB; + view all Sehgal, V; Rosenfeld, A; Graham, DG; Lipman, G; Bisschops, R; Ragunath, K; Rodriguez-Justo, M; Novelli, M; Banks, MR; Haidry, RJ; Lovat, LB; - view fewer (2018) Machine Learning Creates a Simple Endoscopic Classification System that Improves Dysplasia Detection in Barrett's Oesophagus amongst Non-expert Endoscopists. Gastroenterology Research and Practice , Article 1872437. 10.1155/2018/1872437 . Green open access
https://ift.tt/2Ossrbg
Supportive and palliative care in people with cirrhosis: international systematic review of the perspective of patients, family members and health professionals
Low, JTS; Rohde, G; Pittordou, K; Candy, B; Davis, S; Marshall, A; Stone, P; (2018) Supportive and palliative care in people with cirrhosis: international systematic review of the perspective of patients, family members and health professionals. Journal of Hepatology 10.1016/j.jhep.2018.08.028 . (In press). Green open access
https://ift.tt/2y2eA19
Prognostic Value of Serial Galectin-3 Measurements in Patients With Acute Heart Failure
van Vark, LC; Lesman-Leegte, I; Baart, SJ; Postmus, D; Pinto, YM; de Boer, RA; Asselbergs, FW; ... Akkerhuis, KM; + view all van Vark, LC; Lesman-Leegte, I; Baart, SJ; Postmus, D; Pinto, YM; de Boer, RA; Asselbergs, FW; Wajon, EMCJ; Orsel, JG; Boersma, E; Hillege, HL; Akkerhuis, KM; - view fewer (2017) Prognostic Value of Serial Galectin-3 Measurements in Patients With Acute Heart Failure. Journal of the American Heart Association , 6 (12) , Article e003700. 10.1161/JAHA.116.003700 . Green open access
https://ift.tt/2OpRDix
Kv1.3 channel Blockade Modulates the effector Function of B cells in granulomatosis with Polyangiitis
Land, J; Lintermans, LL; Stegeman, CA; Munoz-Elias, EJ; Tarcha, EJ; Iadonato, SP; Heeringa, P; ... Abdulahad, WH; + view all Land, J; Lintermans, LL; Stegeman, CA; Munoz-Elias, EJ; Tarcha, EJ; Iadonato, SP; Heeringa, P; Rutgers, A; Abdulahad, WH; - view fewer (2017) Kv1.3 channel Blockade Modulates the effector Function of B cells in granulomatosis with Polyangiitis. Frontiers in Immunology , 8 , Article 1205. 10.3389/fimmu.2017.01205 . Green open access
https://ift.tt/2y2e8Qv
Performance Evaluation on Intellectual Property Rights Policy System of the Renewable Energy in China
Gao, X; Zhai, K; (2018) Performance Evaluation on Intellectual Property Rights Policy System of the Renewable Energy in China. Sustainability , 10 (6) p. 2097. 10.3390/su10062097 . Green open access
https://ift.tt/2OpFolT
The current state of autography
Grigoriadis, K; (2018) The current state of autography. International Journal of Rapid Manufacturing , 7 (2/3) 10.1504/IJRAPIDM.2018.092902 .
https://ift.tt/2y4eki3
Accelerating the development of therapeutic strategies for drug-resistant tuberculosis
Vjecha, MJ; Tiberi, S; Zumla, A; (2018) Accelerating the development of therapeutic strategies for drug-resistant tuberculosis. [Editorial comment]. Nature Reviews Drug Discovery , 17 (9) pp. 607-608. 10.1038/nrd.2018.28 . Green open access
https://ift.tt/2OpRg7D
Gap junction protein Connexin-43 is a direct transcriptional regulator of N-cadherin in vivo
Kotini, M; Barriga, EH; Leslie, J; Gentzel, M; Rauschenberger, V; Schambon, A; Mayor, R; (2018) Gap junction protein Connexin-43 is a direct transcriptional regulator of N-cadherin in vivo. Nature Communications , 9 , Article 3846. 10.1038/s41467-018-06368-x . Green open access
https://ift.tt/2y2VKac
Mitigating the risks of global spread of Lassa fever at the 2018 Hajj pilgrimage
Gautret, P; Okolo, S; Elachola, H; Zumla, A; Memish, ZA; (2018) Mitigating the risks of global spread of Lassa fever at the 2018 Hajj pilgrimage. Travel Medicine and Infectious Disease , 23 pp. 99-100. 10.1016/j.tmaid.2018.04.016 .
https://ift.tt/2OjVwWn
Limiting consumption in tuberculosis: current concepts in anti-tuberculosis treatment in the critically ill patient
Mer, M; Zumla, A; Dünser, MW; (2018) Limiting consumption in tuberculosis: current concepts in anti-tuberculosis treatment in the critically ill patient. Intensive Care Medicine 10.1007/s00134-018-5161-5 . (In press). Green open access
https://ift.tt/2y6Akc0
Sex and species specific hearing mechanisms in mosquito flagellar ears
Su, MP; Andrés, M; Boyd-Gibbins, N; Somers, J; Albert, JT; (2018) Sex and species specific hearing mechanisms in mosquito flagellar ears. Nature Communications , 9 , Article 3911. 10.1038/s41467-018-06388-7 . Green open access
https://ift.tt/2OrTVO4
Reply to 'Revisiting signatures of neutral tumor evolution in the light of complexity of cancer genomic data
Williams, MJ; Werner, B; Heide, T; Barnes, CP; Graham, TA; Sottoriva, A; (2018) Reply to 'Revisiting signatures of neutral tumor evolution in the light of complexity of cancer genomic data. [Letter]. Nature Genetics 10.1038/s41588-018-0210-0 . (In press).
https://ift.tt/2xZocte
Improved fragment-based protein structure prediction by redesign of search heuristics
Kandathil, SM; Garza-Fabre, M; Handl, J; Lovell, SC; (2018) Improved fragment-based protein structure prediction by redesign of search heuristics. Scientific Reports , 8 , Article 13694. 10.1038/s41598-018-31891-8 . Green open access
https://ift.tt/2OpQvLP
The macroecological dynamics of species coexistence in birds
Pigot, AL; Jetz, W; Sheard, C; Tobias, JA; (2018) The macroecological dynamics of species coexistence in birds. Nature Ecology and Evolution , 2 (7) pp. 1112-1119. 10.1038/s41559-018-0572-9 .
https://ift.tt/2y73mYX
An open source pharma roadmap
Balasegaram, M; Kolb, P; Mckew, J; Menon, J; Olliaro, P; Sablinski, T; Thomas, Z; ... Wilbanks, J; + view all Balasegaram, M; Kolb, P; Mckew, J; Menon, J; Olliaro, P; Sablinski, T; Thomas, Z; Todd, MH; Torreele, E; Wilbanks, J; - view fewer (2017) An open source pharma roadmap. PloS Medicine , 14 (4) 10.1371/journal.pmed.1002276 . Green open access
https://ift.tt/2Ouh2re
The added value of online user-generated content in traditional methods for influenza surveillance
Wagner, M; Lampos, V; Cox, IJ; Pebody, R; (2018) The added value of online user-generated content in traditional methods for influenza surveillance. Scientific Reportsvolume , 8 , Article 13963. 10.1038/s41598-018-32029-6 . Green open access
https://ift.tt/2y1dnXP
Learning hard quantum distributions with variational autoencoders
Rocchetto, A; Grant, E; Strelchuk, S; Carleo, G; Severini, S; (2018) Learning hard quantum distributions with variational autoencoders. npj Quantum Information , 4 , Article 28. 10.1038/s41534-018-0077-z . Green open access
https://ift.tt/2OpoqV2
VX15/2503 in Combination With Ipilimumab or Nivolumab in Patients With Head and Neck Cancer
Condition: Squamous Cell Carcinoma of the Head and Neck
Interventions: Biological: VX15/2503; Biological: Ipilimumab; Biological: Nivolumab
Sponsors: Emory University; Vaccinex Inc.
Not yet recruiting
https://ift.tt/2P3Fb4X
Interventions: Biological: VX15/2503; Biological: Ipilimumab; Biological: Nivolumab
Sponsors: Emory University; Vaccinex Inc.
Not yet recruiting
https://ift.tt/2P3Fb4X
Study of SHR-1210 in Combination With Chemotherapy in Advanced Esophageal Cancer
Condition: Advanced Esophageal Cancer
Interventions: Drug: SHR-1210; Drug: Placebo; Drug: paclitaxel; Drug: cisplatin
Sponsor: Jiangsu HengRui Medicine Co., Ltd.
Not yet recruiting
https://ift.tt/2OsJI3O
Interventions: Drug: SHR-1210; Drug: Placebo; Drug: paclitaxel; Drug: cisplatin
Sponsor: Jiangsu HengRui Medicine Co., Ltd.
Not yet recruiting
https://ift.tt/2OsJI3O
Comparative Effectiveness Trial of Transoral Head and Neck Surgery Followed by Adjuvant Radio(Chemo)Therapy Versus Primary Radiochemotherapy for Oropharyngeal Cancer
Condition: Oropharyngeal Cancer
Interventions: Procedure: Resection; Radiation: Radiotherapy; Drug: Chemotherapy; Procedure: Salvage neck dissection
Sponsors: Universitätsklinikum Hamburg-Eppendorf; Charite University, Berlin, Germany; University Medical Center Gießen and Marburg GmbH; University Medical Center Ulm
Recruiting
https://ift.tt/2P2Rajt
Interventions: Procedure: Resection; Radiation: Radiotherapy; Drug: Chemotherapy; Procedure: Salvage neck dissection
Sponsors: Universitätsklinikum Hamburg-Eppendorf; Charite University, Berlin, Germany; University Medical Center Gießen and Marburg GmbH; University Medical Center Ulm
Recruiting
https://ift.tt/2P2Rajt
A Study of Cabozantinib Compared With Placebo in Subjects With Radioiodine-refractory Differentiated Thyroid Cancer Who Have Progressed After Prior VEGFR-targeted Therapy
Condition: Differentiated Thyroid Cancer
Interventions: Drug: Cabozantinib; Drug: Placebo
Sponsor: Exelixis
Not yet recruiting
https://ift.tt/2OoMkQo
Interventions: Drug: Cabozantinib; Drug: Placebo
Sponsor: Exelixis
Not yet recruiting
https://ift.tt/2OoMkQo
Exome sequencing confirms diagnosis of kabuki syndrome in an-adult with hodgkin lymphoma and unusually severe multisystem phenotype
Publication date: Available online 30 September 2018
Source: Clinical Immunology
Author(s): Charu Kaiwar, Teresa M. Kruisselbrink, Yogish C. Kudva, Eric W. Klee, Pavel Pichurin
Abstract
We report a 34-year-old male patient with a novel variant in KMT2D gene, which finally ended a quest for a diagnosis that was clinically suspected in the past, prior the molecular basis of Kabuki Syndrome (KS) was known. The patient showcases the multisystemic features, with involvement of all previously associated with KS body systems, presence of immune deficiency as well as autoimmune disorders, requiring three pancreatic transplants. We also report, for the first time to our knowledge, the presence of epidural lipomatosis and Hodgkin Lymphoma in a patient with KS.
https://ift.tt/2OvpAOU
Decision making in advanced larynx cancer: An evidenced based review
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Antoine Eskander, Dukagjin M. Blakaj, Peter T. Dziegielewski
Abstract
Organ preservation versus total laryngectomy for advanced laryngeal cancer continues to be hotly debated. This review presents evidence-based decision making points for these patents.
https://ift.tt/2P0Jnm5
Schmerztherapie bei Darmkrebspatienten
Zusammenfassung
Hintergrund
Die adäquate Behandlung von Schmerzen ist ein wichtiger Bestandteil in der Versorgung von Krebspatienten, doch mangelt es bisher an Studien, die den Gebrauch von Schmerzmitteln bzw. adjuvanten Schmerztherapeutika bei Krebspatienten systematisch untersuchen.
Ziel
Die Quantifizierung des Gebrauchs von Schmerzmitteln und adjuvanten Schmerztherapeutika wird am Beispiel von Darmkrebspatienten in verschiedenen Zeiträumen vor und nach Diagnose beschrieben.
Material und Methoden
Für die Studie wurde die pharmakoepidemiologische Forschungsdatenbank GePaRD (German Pharmacoepidemiological Research Database) verwendet, die Abrechnungsdaten von 4 gesetzlichen Krankenkassen enthält. Darmkrebspatienten mit Erstdiagnose im Jahr 2010 wurden mittels ICD-Kodes (C18-C20) identifiziert und über 5 Jahre nachbeobachtet. Die Autoren berechneten für verschiedene Zeiträume vor und nach Diagnose jeweils den Anteil an Patienten, die Opioide, nichtopioide Schmerzmittel, bestimmte adjuvante Schmerztherapeutika (Antidepressiva und die Antikonvulsiva Pregabalin und Gabapentin) und Benzodiazepine erhielten (Verordnungsprävalenz) und ermittelten für die Arzneimittelgruppen die am häufigsten verordneten Wirkstoffe. Je nach Schweregrad der Erkrankung bei Diagnose bzw. Metastasenbildung im Verlauf wurde zwischen 3 Patientengruppen unterschieden.
Ergebnisse
Insgesamt wurden 9596 Patienten mit inzidentem Darmkrebs im Jahr 2010 eingeschlossen. Für Opioide stieg die Verordnungsprävalenz von ~8 % vor Diagnose auf maximal 31 % bei Patienten mit Metastasenbildung. Auf schwach wirksame Opioide entfielen bei Patienten mit fortgeschrittenem Darmkrebs bzw. Metastasenbildung etwa ein Drittel der Tagesdosen, bei den übrigen Patienten zwei Drittel. Die Verordnungsprävalenzen für nichtopioide Schmerzmittel stiegen von ~35 % vor Diagnose auf bis zu 56 % nach Diagnose, für Antidepressiva von ~9 % auf maximal 18 %, für Pregabalin und Gabapentin von 2 % bis maximal 9 % und für Benzodiazepine von 5 % auf maximal 14 %.
Diskussion
Vergleicht man die Ergebnisse mit der verfügbaren Literatur, könnten diese tendenziell auf einen zurückhaltenden Einsatz von Opioiden bei (Darm‑)Krebspatienten hindeuten. In Anbetracht der hohen Verordnungsprävalenz von Arzneimitteln, deren gleichzeitige Gabe schwerwiegende Konsequenzen haben kann, ist bei dieser Patientengruppe hinsichtlich Arzneimittelinteraktionen besondere Vorsicht geboten.
https://ift.tt/2xZAvpA
As Hunters find their Game by the Trace': Reading to Discover in The Anatomy of Melancholy
Gowland, AMT; (2019) As Hunters find their Game by the Trace': Reading to Discover in The Anatomy of Melancholy. [Review]. Review of English Studies (In press).
https://ift.tt/2DSO54u
Promoting the clearance of neurotoxic proteins in neurodegenerative disorders of ageing
Boland, B; Yu, WH; Corti, O; Mollereau, B; Henriques, A; Bezard, E; Pastores, GM; ... Millan, MJ; + view all Boland, B; Yu, WH; Corti, O; Mollereau, B; Henriques, A; Bezard, E; Pastores, GM; Rubinsztein, DC; Nixon, RA; Duchen, MR; Mallucci, GR; Kroemer-, G; Levine, B; Eskelinen, E-L; Mochel, F; Spedding, M; Louis, C; Martin, OR; Millan, MJ; - view fewer (2018) Promoting the clearance of neurotoxic proteins in neurodegenerative disorders of ageing. Nature Reviews Drug Discovery , 17 (9) pp. 660-688. 10.1038/nrd.2018.109 .
https://ift.tt/2Oo9lmr
The Public Domain
Fhima, IR; (2018) The Public Domain. Intellectual Property Quarterly (In press).
https://ift.tt/2DJniaz
Commentary: The formal approach to quantitative causal inference in epidemiology: misguided or misrepresented?
Daniel, RM; De Stavola, BL; Vansteelandt, S; (2016) Commentary: The formal approach to quantitative causal inference in epidemiology: misguided or misrepresented? International Journal of Epidemiology , 45 (6) pp. 1817-1829. 10.1093/ije/dyw227 . Green open access
https://ift.tt/2OtJjhC
Analogical cognition: an insight into word meaning
Pritchard, TD; (2018) Analogical cognition: an insight into word meaning. Review of Philosophy and Psychology 10.1007/s13164-018-0419-y . (In press). Green open access
https://ift.tt/2DLxQWO
Open Source Drug Discovery: Highly Potent Antimalarial Compounds Derived from the Tres Cantos Arylpyrroles
Williamson, AE; Ylioja, PM; Robertson, MN; Antonova-Koch, Y; Avery, V; Baell, JB; Batchu, H; ... Todd, MH; + view all Williamson, AE; Ylioja, PM; Robertson, MN; Antonova-Koch, Y; Avery, V; Baell, JB; Batchu, H; Batra, S; Burrows, JN; Bhattacharyya, S; Calderon, F; Charman, SA; Clark, J; Crespo, B; Dean, M; Debbert, SL; Delves, M; Dennis, ASM; Deroose, F; Duffy, S; Fletcher, S; Giaever, G; Hallyburton, I; Gamo, F-J; Gebbia, M; Guy, RK; Hungerford, Z; Kirk, K; Lafuente-Monasterio, MJ; Lee, A; Meister, S; Nislow, C; Overington, JP; Papadatos, G; Patiny, L; Pham, J; Ralph, SA; Ruecker, A; Ryan, E; Southan, C; Srivastava, K; Swain, C; Tarnowski, MJ; Thomson, P; Turner, P; Wallace, IM; Wells, TNC; White, K; White, L; Willis, P; Winzeler, EA; Wittlin, S; Todd, MH; - view fewer (2016) Open Source Drug Discovery: Highly Potent Antimalarial Compounds Derived from the Tres Cantos Arylpyrroles. ACS Central Science , 2 (10) pp. 687-701. 10.1021/acscentsci.6b00086 . Green open access
https://ift.tt/2OrBOI5
The boundaries of legal personhood: how spontaneous intelligence can problematise differences between humans, artificial intelligence, companies and animals
Burgess, P; Chen, J; (2018) The boundaries of legal personhood: how spontaneous intelligence can problematise differences between humans, artificial intelligence, companies and animals. Artificial Intelligence and Law 10.1007/s10506-018-9229-x . (In press). Green open access
https://ift.tt/2DMmhOX
Synthesis and Evaluation of 1,8-Disubstituted-Cyclam/Naphthalimide Conjugates as Probes for Metal Ions
Wong, JK-H; Ast, S; Yu, M; Flehr, R; Counsell, AJ; Turner, P; Crisologo, P; ... Rutledge, PJ; + view all Wong, JK-H; Ast, S; Yu, M; Flehr, R; Counsell, AJ; Turner, P; Crisologo, P; Todd, MH; Rutledge, PJ; - view fewer (2016) Synthesis and Evaluation of 1,8-Disubstituted-Cyclam/Naphthalimide Conjugates as Probes for Metal Ions. ChemistryOpen , 5 (4) pp. 375-385. 10.1002/open.201600010 . Green open access
https://ift.tt/2OrBCIR
Usefulness in Contemporary Art and Politics
Abse Gogarty, L; (2017) Usefulness in Contemporary Art and Politics. Third Text , 31 (1) pp. 117-132. 10.1080/09528822.2017.1364920 .
https://ift.tt/2DJngiX
Redundancy in synaptic connections enables neurons to learn optimally
Hiratani, N; Fukai, T; (2018) Redundancy in synaptic connections enables neurons to learn optimally. Proceedings of the National Academy of Sciences , 115 (29) E6871-E6879. 10.1073/pnas.1803274115 .
https://ift.tt/2OpLnHD
Nocturnal supervision and SUDEP risk at different epilepsy care settings
van der Lende, M; Hesdorffer, DC; Sander, JW; Thijs, RD; (2018) Nocturnal supervision and SUDEP risk at different epilepsy care settings. Neurology 10.1212/WNL.0000000000006356 . (In press).
https://ift.tt/2DLFwrS
Refractory juvenile myoclonic epilepsy: A meta-analysis of prevalence and risk factors
Stevelink, R; Koeleman, BPC; Sander, JW; Jansen, FE; Braun, KPJ; (2018) Refractory juvenile myoclonic epilepsy: A meta-analysis of prevalence and risk factors. European Journal of Neurology 10.1111/ene.13811 . (In press).
https://ift.tt/2OtIGVi
Understanding the quality of life of family carers of people with dementia: Development of a new conceptual framework
Daley, S; Murray, J; Farina, N; Page, TE; Brown, A; Basset, T; Livingston, G; ... Banerjee, S; + view all Daley, S; Murray, J; Farina, N; Page, TE; Brown, A; Basset, T; Livingston, G; Bowling, A; Knapp, M; Banerjee, S; - view fewer (2018) Understanding the quality of life of family carers of people with dementia: Development of a new conceptual framework. International Journal of Geriatric Psychiatry 10.1002/gps.4990 . (In press). Green open access
https://ift.tt/2DSNT5g
An Evaluation of the Potential of NMR Spectroscopy and Computational Modelling Methods to Inform Biopharmaceutical Formulations
Pandya, A; Howard, MJ; Zloh, M; Dalby, PA; (2018) An Evaluation of the Potential of NMR Spectroscopy and Computational Modelling Methods to Inform Biopharmaceutical Formulations. Pharmaceutics , 10 (4) , Article 165. 10.3390/pharmaceutics10040165 . Green open access
https://ift.tt/2OtIvcA
Addressing the most neglected diseases through an open research model: The discovery of fenarimols as novel drug candidates for eumycetoma
Lim, W; Melse, Y; Konings, M; Hung, PD; Eadie, K; Laleu, B; Perry, B; ... van de Sande, WWJ; + view all Lim, W; Melse, Y; Konings, M; Hung, PD; Eadie, K; Laleu, B; Perry, B; Todd, MH; Ioset, J-R; van de Sande, WWJ; - view fewer (2018) Addressing the most neglected diseases through an open research model: The discovery of fenarimols as novel drug candidates for eumycetoma. PLoS Neglected Tropical Diseases , 12 (4) , Article e0006437. 10.1371/journal.pntd.0006437 . Green open access
https://ift.tt/2DLsMSl
Proteomic analysis of S-nitrosylated nuclear proteins in rat cortical neurons
Smith, JG; Aldous, SG; Andreassi, C; Cuda, G; Gaspari, M; Riccio, A; (2018) Proteomic analysis of S-nitrosylated nuclear proteins in rat cortical neurons. Science Signaling , 11 (537) , Article eaar3396. 10.1126/scisignal.aar3396 . Green open access
https://ift.tt/2OtIghG
Quality of care for frail older adults
Moore, KJ; (2018) Quality of care for frail older adults. [Editorial comment]. International Psychogeriatrics , 30 (9) pp. 1255-1257. 10.1017/S1041610218001321 . Green open access
https://ift.tt/2DIPLxl
Electromagnetic radiofrequency radiation with special reference to otorhinolaryngology and brain tumors
Publication date: Available online 30 September 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Sergei V. Jargin
https://ift.tt/2Op6h9L
Novel three-dimensional image system for endoscopic ear surgery
Abstract
Objective
The objective of this study was to evaluate the clinical outcomes of conventional two-dimensional (2D) endoscope with a novel computer-based three-dimensional (3D) imaging system for otologic surgical procedures.
Methods
A conventional 2D monocular endoscope with a novel computer-based 3D imaging system was applied to 18 otologic surgical procedures, including chronic otitis media (COM), cholesteatoma, otosclerosis, external canal osteoma and cochlear implant. Operation duration and complications of COM and attic cholesteatoma were recorded to compare 2D and 3D endoscopic ear surgery. Questionnaires were completed by 35 observers participating in the procedures and were used to evaluate clinical and potential side effects.
Results
The surgical procedures were performed smoothly for all patients. No patient required switching to conventional 2D endoscopic surgery. No significant differences were apparent in operation duration using the 3D imaging system for chronic otitis media and attic cholesteatoma compared with conventional 2D endoscopic ear surgery. Thirty-five observers completed the questionnaires. Most of them agreed that this 3D imaging system enabled them to perceive stereoscopic vision (94%), provide superior depth perception (85%). Furthermore, 97.1% reported no visual fatigue or discomfort when observing the 3D images.
Conclusion
Our study demonstrated that the computer-based 3D imaging system enables the application of 3D vision technology to otologic surgery. The system has no obvious side effects, such as visual fatigue or time delay. It not only facilitates performing the related surgical procedures but also helps in teaching and learning endoscopic ear surgeries.
https://ift.tt/2DLeGQV
Genetic variants in ACTN3 and MYO1H are associated with sagittal and vertical craniofacial skeletal patterns
Publication date: Available online 30 September 2018
Source: Archives of Oral Biology
Author(s): Arthur Cunha, Paulo Nelson-Filho, Guido Artemio Marañón-Vásquez, Alice Gomes de Carvalho Ramos, Beatriz Dantas, Aline Monise Sebastiani, Felipe Silvério, Marjorie Ayumi Omori, Amanda Silva Rodrigues, Ellen Cardoso Teixeira, Simone Carvalho Levy, Marcelo Calvo de Araújo, Mírian Aiko Nakane Matsumoto, Fábio Lourenço Romano, Lívia Azeredo A. Antunes, Delson João da Costa, Rafaela Scariot, Leonardo Santos Antunes, Alexandre R. Vieira, Erika C. Küchler
ABSTRACT
Objective
This study aimed to evaluate the association of genetic variants inACTN3 and MYO1H with craniofacial skeletal patterns in Brazilians.
Design
This cross-sectional study enrolled orthodontic and orthognathic patients selected from 4 regions of Brazil. Lateral cephalograms were used and digital cephalometric tracings and analyzes were performed for craniofacial phenotype determination. Participants were classified according to the skeletal malocclusion in Class I, II or III; and according to the facial type in Mesofacial, Dolichofacial or Brachyfacial. Genomic DNA was extracted from saliva samples containing exfoliated buccal epithelial cells and analyzed for genetic variants inACTN3 (rs678397 and rs1815739) and MYO1H (rs10850110) by real-time PCR. Chi-square or Fisher's exact tests were used for statistical analysis (α = 5%).
Results
A total of 646 patients were included in the present study. There was statistically significant association of the genotypes and/or alleles distributions with the skeletal malocclusion (sagittal skeletal pattern) and facial type (vertical pattern) for the variants assessed inACTN3 (P < 0.05). For the genetic variant evaluated in MYO1H, there was statistically significant difference between the genotypes frequencies for skeletal Class I and Class II (P < 0.05). The reported associations were different depending on the region evaluated.
Conclusion
ACTN3 and MYO1H are associated with sagittal and vertical craniofacial skeletal patterns in Brazilian populations.
https://ift.tt/2y3ndbz
Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: a modeling study of cost‐effectiveness
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2RdBfjN
The use of Bone Conduction Hearing Implants (BCHI) in Paediatric Chronic Otitis Media: An audit of outcomes of 32 devices in 22 patients
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NdK9uv
The effect of the opioid epidemic on donation after cardiac death transplantation outcomes
Background The opioid abuse epidemic and the deaths of otherwise healthy individuals due to drug overdose in the United States has major implications for transplantation. The current extent and safety of utilization of liver and kidney grafts from donation after cardiac death (DCD) donors who died in the context of opioid overdose is unknown. Methods Using national data from 2006 to 2016, we estimated the cumulative incidence of graft failure for recipients of DCD grafts, comparing the risk amongst recipients of organs from donors who died of anoxic drug overdose and recipients of organs from donors who died of other causes. Results One hundred and seventy-nine (6.2%) of 2908 liver graft recipients and 944 (6.1%) of 15 520 kidney graft recipients received grafts from donors who died of anoxic drug overdose. Grafts from anoxic drug overdose donors were less frequently utilized compared to other DCD grafts (liver: 25.9% vs. 29.6%, 95% CI for difference, -6.7 to -0.7%; kidney: 81.0% vs. 84.7%; CI for difference, -7.3 to -0.1%). However, the risk of graft failure at 5-years was similar for recipients of anoxic drug overdose donor grafts and recipients of other grafts (liver risk difference: 1.8% [95% CI, -7.8 to 11.8%], kidney risk difference: -1.5% [95% CI, -5.4 to 3.1%]). Conclusions In the context of the current opioid epidemic, utilization of anoxic drug overdose DCD donor grafts does not increase the risk of graft failure and may help to address waitlist demands. MH and RHA contributed to this work equally as senior authors, Miguel A. Hernán, MD, DrPH, Roberto Hernandez-Alejandro, MD Disclaimers and conflict of interest: None Contact information for corresponding authors: Kerollos N. Wanis, Department of Surgery, Western University. London Health Sciences Centre, Rm. C8-114, London, Ontario, Canada, N6A 5A5. knwanis@g.harvard.edu Authorship KNW, AM, KD, MH, and RHA participated in the study conception and design. KNW, AM, and MH participated in the data analysis. KNW, MH, and RHA wrote the article. AM, KD, KT, and BA-J provided critical revisions of the manuscript for important intellectual content. SRTR disclaimer: The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2P1PJSf
https://ift.tt/2P1PJSf
Kaposi sarcoma in HIV-positive solid organ transplant recipients: A French multicentric national study and literature review
Background Kaposi sarcoma is a vascular tumor related to herpesvirus-8 and is promoted by immunosuppression. For the last 15 years, HIV patients have had access to organ transplantation. The dual immunosuppression of HIV and immunosuppressive treatments might increase the risk and severity of Kaposi sarcoma. Methods We conducted a multicentric retrospective study by collecting cases from French databases and society members of transplanted patients, among which 7 HIV-infected patients who subsequently developed Kaposi sarcoma were included. Results In the CRISTAL database (114 511 patients) and the DIVAT database (19 077 patients), the prevalence of Kaposi sarcoma was 0.18% and 0.46%, respectively, in transplanted patients; these values compare with 0.66% and 0.50%, respectively, in transplanted patients with HIV. The median time from HIV infection to Kaposi sarcoma was 20 years. Kaposi sarcoma occurred during the first year after transplantation in most cases, while HIV viral load was undetectable. Only 2 patients had visceral involvement. Five patients were treated with conversion of calcineurin inhibitor to mTOR inhibitor, and 5 patients were managed by decreasing immunosuppressive therapies. At 1 year, 4 patients had a complete response, and 3 had a partial response. Conclusions In our study, Kaposi sarcoma in transplanted patients with HIV did not show any aggressive features and was treated with the usual posttransplant Kaposi sarcoma management protocol. Corresponding authors' email addresses chloe.charpentier@aphp.fr julie.delyon@aphp.fr denis.glotz@aphp.fr marie-noelle.peraldi@aphp.fr jean-philippe.rerolle@chu-limoges.fr benoit.barrou@aphp.fr emilie.ducroux@chu-lyon.fr audreycoilly@gmail.com camille.legeai@biomedecine.fr stephane.barete@aphp.fr celeste.lebbe@aphp.fr Charpentier Chloé participated in the writing of the paper, participated in the research design, participated in the performance of the research, contributed new reagents or analytic tools, and participated in the data analysis Delyon Julie participated in the writing of the paper, participated in the research design, participated in the performance of the research, contributed new reagents or analytic tools, and participated in the data analysis Glotz Denis participated in the research design, participated in the performance of the research, and contributed new reagents or analytic tools Peraldi Marie-Noelle participated in the performance of the research and contributed new reagents or analytic tools Rerolle Jean-Philippe participated in the performance of the research and contributed new reagents or analytic tools Barrou Benoît participated in the performance of the research and contributed new reagents or analytic tools Ducroux Emilie participated in the performance of the research and contributed new reagents or analytic tools Coilly Audrey participated in the performance of the research and contributed new reagents or analytic tools Legeai Camille participated in the performance of the research and contributed new reagents or analytic tools Barete Stéphane participated in research design, participated in the performance of the research, and contributed new reagents or analytic tools Lebbé Céleste participated in the writing of the paper, participated in the research design, participated in the performance of the research, contributed new reagents or analytic tools, and participated in the data analysis Conflict of interest The authors declare no conflicts of interest. Funding No funding was received for this work Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2Rk7fTs
https://ift.tt/2Rk7fTs
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