Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Calcium phosphate cement cranioplasty decreases the rate of CSF leak and wound infection compared to titanium mesh cranioplasty: retrospective study of 672 patients.
World Neurosurg. 2016 Feb 24;
Authors: Foster KA, Shin SS, Prabhu B, Fredrickson A, Sekula RF
PMID: 26921704 [PubMed - as supplied by publisher]
Disseminated intravascular coagulation in secondary glioblastoma due to excessive intraoperative bleeding - case report and review of the literature.
World Neurosurg. 2016 Feb 24;
Authors: Pinggera D, Kerschbaumer J, Innerhofer N, Woehrer A, Freyschlag CF, Thomé C
Abstract
BACKGROUND: Disseminated intravascular coagulation (DIC) describes a pathological activation of coagulation mechanisms, leading to thrombi in various organs with contribution to multiple organ failure. In clinical practice, diagnosis of DIC can often be made by laboratory values, including prolonged coagulation times, thrombocytopenia or high levels of fibrin degradation products. DIC is frequently observed after neurotrauma, but rarely occurs in patients with primary brain tumors. There are only few case reports of DIC in patients with primary brain tumors, all sharing the highly elevated mortality. We report the case of a young patient presenting with secondary glioblastoma, who developed multi-organ failure induced by DIC following extensive intraoperative bleeding.
CASE DESCRIPTION: A 30-year-old patient was admitted in poor general condition with insomnia, severe headache and vomiting. She had undergone surgery for secondary glioblastoma twice. MRI revealed a left temporoparietal mass lesion with indication for resection. Surgery then was complicated by diffuse intraoperative bleeding due to a high content of microvascular proliferation as shown in the histopathological workup. Subsequently, an uncontrollable multi-organ failure developed, causing the patient`s death four days after surgery.
CONCLUSIONS: Although a rare complication, in excessive intraoperative bleeding, especially in surgery for brain tumors located next to the ventricular system, disseminated intravascular coagulation should be kept in mind as a possible diagnosis.
PMID: 26921703 [PubMed - as supplied by publisher]
Radiological surveillance of untreated unruptured intracranial aneurysms: A single surgeon's experience.
World Neurosurg. 2016 Feb 24;
Authors: Teo M, St George EJ
Abstract
BACKGROUND: The management of untreated unruptured intracranial aneurysms remains controversial, the natural history is still not well understood and many patients are not routinely followed up. We present a single surgeon's data on radiological surveillance of these lesions.
METHODS: 94 patients with 152 unruptured intracranial aneurysms, with a mean follow up time of 3.4years from the time of diagnosis, underwent surveillance using CTA, MRA or DSA. Aneurysm growth was defined as an increase in one or more dimensions above the measurement error. Statistical analysis was performed.
RESULTS: Of 152 aneurysms, 126 (83%) were less than 7mm, 25 (16%) were 7-12mm and 1 aneurysm was 13-24mm. 18 of 152 (12%) cerebral aneurysms in 17 patients grew larger. 7% (9/126) of aneurysm <7mm, and 36% (9/25) of aneurysm 7-12mm enlarged. Spontaneous aneurysmal rupture occurred in 4 of 152 (2.6%) of aneurysms, ie 4/94 patients (4%), with an average initial aneurysm size of 5.7mm. The risk of aneurysm rupture per patient-year was 5% with growth, 0.2% without growth and there was a 24-fold increase in aneurysmal rupture risk for growing aneurysm (p=0.005). 15% (16/109) of aneurysms in group 1(no previous SAH), compared to 5% (2/43) of group 2 (previous SAH) aneurysms showed evidence of growth during the study period (p=0.0424).
CONCLUSIONS: These results support imaging follow up of patients with untreated unruptured intracranial aneurysms, including those with aneurysms smaller than the current treatment threshold of 7mm. Apart from the initial size, aneurysm growth is also associated with an increased risk of SAH and therefore growing aneurysms warrant treatment. The data also demonstrated that incidental aneurysms, in patients without previous SAH, do not behave less aggressively, contrary to current opinion.
PMID: 26921702 [PubMed - as supplied by publisher]
Postoperative stereotactic radiosurgery (SRS) utilizing 5 Gy X 5 sessions in the management of brain metastases.
World Neurosurg. 2016 Feb 24;
Authors: Abuodeh Y, Ahmed KA, Naghavi AO, Venkat PS, Sarangkasiri S, Johnstone PA, Etame AB, Yu HM
Abstract
BACKGROUND: Multiple regimens for stereotactic radiosurgery to the post-operative bed have shown a high local control rate and a low toxicity profile with no decrease in overall survival with the omission of whole brain radiation therapy.
METHODS: In this retrospective analysis, we evaluate our experience with post-operative SRS using a uniform regimen of 25 Gy in 5 sessions.
RESULTS: Between April 2011 to May 2014, a total of 75 patients treated to 77 metastatic brain lesions with post-operative stereotactic radiosurgery in 5 sessions. The median PTV was 13.8 cm3 (1.93-128.43 cm3) with a median follow up for all lesions of 9.5 months (range 1.2-38.2 months). Kaplan-Meier estimates of local control at 1 and 2 years were 88.8% and 83.9%, respectively. On univariate analysis, a trend in decreased survival with multiple brain lesions was noted (HR=2 (95% CI 0.87-4.53), p=0.10). There was a trend towards decreased local control with radioresistant tumors (HR=3.23 (0.7-22.6), p=0.14) and PTV volume ≥ 17 cm3 (HR= 3.07 (0.73-15.23), p=0.12). Two (3%) patients developed radionecrosis, one of them required craniotomy.
CONCLUSION: SRS with a dose of 25 Gy in 5 sessions is associated with excellent local control at the resection site with minimal toxicity in the postoperative settings in our patient population. Further investigation is required to determine if dose escalation to the post-operative cavity of radioresistant tumors improves outcomes.
PMID: 26921701 [PubMed - as supplied by publisher]
Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Technology: A Clinical and Radiographic Analysis of 50 Patients.
World Neurosurg. 2016 Feb 24;
Authors: Kim CW, Doerr TM, Luna IY, Joshua G, Shen SR, Fu X, Wu AM
Abstract
OBJECTIVE: Interbody cage implantation during minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF) presents challenges. Expandable cages when collapsed facilitate insertion; subsequent expansion in situ optimizes endplate contact. This report describes clinical and radiographic outcomes of MIS TLIF with an expandable cage.
METHODS: Researchers retrospectively analyzed prospective data from 50 patients (62 operative levels) when an expandable interbody spacer was combined with transpedicular posterior stabilization. Clinical outcomes, fusion rates, incidence of reoperation, and device-related complications were obtained from clinical and radiographic records.
RESULTS: Mean patient age was 58.1 years (56.2% female). In all, 76% (38/50) underwent single-level fusion, and 24% (12/50) two-level fusion. Average operative time was 239 ± 87 minutes for single-level and 350 ± 75 minutes for two-level procedures; average hospital stay overall was 2.5 ± 1.7 days, with no intraoperative complications reported. Mean visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores decreased significantly from preoperative to all postoperative assessment times (6, 12, and 24 months) (P < 0.05). Intervertebral disc height (8 ± 3 vs 11 ± 2 mm) increased significantly, with increases sustained over 24 months (P < 0.05). Postoperative radiographs showed no evidence of cage migration, subsidence, or collapse and suggested fusion at all operative levels by 12 months and 24 months (93%, 54/58; 97%, 28/29), respectively.
CONCLUSIONS: An expandable interbody cage led to significant improvement in clinical and radiographic outcomes following MIS TLIF, including intervertebral disc height restoration and high fusion rates, with no evidence of device-related complications.
PMID: 26921700 [PubMed - as supplied by publisher]
The Efficacy of Antibacterial Prophylaxis against the Development of Meningitis after Craniotomy: a Meta-analysis.
World Neurosurg. 2016 Feb 24;
Authors: Alotaibi AF, Hulou MM, Vestal M, Alkholifi F, Asgarzadeh M, Cote DJ, Bi WL, Dunn IF, Mekary RA, Smith TR
Abstract
BACKGROUND: Prophylactic antibiotics are widely used before craniotomy to prevent postoperative infections.
OBJECTIVE: A systematic review and meta-analysis was conducted to examine the effect of prophylactic antibiotics on post-craniotomy meningitis.
METHODS: PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials (RCTs) that evaluated the effect of prophylactic antibiotics on post-craniotomy meningitis. Pooled effect estimates were calculated using fixed- and random-effects models.
RESULTS: Seven studies with 2365 patients were included in the final analysis. All studies were randomized controlled trials with different antibiotic regimens. Prophylactic antibiotic use reduced the rate of post-neurosurgical meningitis, with a pooled Peto Odds ratio of 0.34 (95% CI: 0.18; 0.63). Cochran's Q test indicated no significant heterogeneity among studies (I(2) =0%; P-for heterogeneity =0.44). Subgroup analysis based on gram-negative coverage, blinding design, and study quality demonstrated no statistically significant difference among these groups (P > 0.05 for all). A meta-regression on surgery duration (P=0.52) and on antibiotics duration (P=0.59) did not show significant differences in the results among studies.
CONCLUSION: This meta-analysis shows that prophylactic antibiotic use significantly decreases post-craniotomy meningitis infections.
PMID: 26921699 [PubMed - as supplied by publisher]
The Negative Impact of Anemia on Outcome from Traumatic Brain Injury.
World Neurosurg. 2016 Feb 24;
Authors: Litofsky NS, Martin S, Diaz J, Ge B, Petroski G, Miller DC, Barnes SL
PMID: 26921698 [PubMed - as supplied by publisher]
Comparative Effectiveness of the Different Treatment Modalities for Snoring.
Otolaryngol Head Neck Surg. 2016 Mar;154(3):577-8
Authors: Delsupehe K, Terryn S, Bouckaert B
PMID: 26921405 [PubMed - in process]
Letter to the Editor on "Comparative Effectiveness of the Different Treatment Modalities for Snoring".
Otolaryngol Head Neck Surg. 2016 Mar;154(3):577
Authors: Ugur KS, Dağlı E, Ark N, Kurtaran H
PMID: 26921404 [PubMed - in process]
Response to Comment on "Olfactory Function Assessment of Blind Subjects Using the Sniffin' Sticks Test".
Otolaryngol Head Neck Surg. 2016 Mar;154(3):576-7
Authors: Çomoğlu Ş
PMID: 26921403 [PubMed - in process]
Comment on "Olfactory Function Assessment of Blind Subjects Using the Sniffin' Sticks Test".
Otolaryngol Head Neck Surg. 2016 Mar;154(3):576
Authors: Kaya A, Binar M
PMID: 26921402 [PubMed - in process]
Regarding "Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis" by Ishii et al, 2015.
Otolaryngol Head Neck Surg. 2016 Mar;154(3):575
Authors: Stupak HD
PMID: 26921401 [PubMed - in process]
Highlights from the Current Issue: March 2016.
Otolaryngol Head Neck Surg. 2016 Mar;154(3):401-2
Authors: Krouse JH
PMID: 26921400 [PubMed - in process]
Objective. To investigate the changes in serum Myeloid-Related Protein 8/14 (MRP8/14) and Eosinophil Cationic Protein (ECP) levels in patients with different types of coronary artery diseases (CAD) and assess the value of MRP8/14 and ECP detection in predicting CAD. Methods. 178 patients were divided into CAD group including unstable angina pectoris (UAP), acute myocardial infarction (AMI), and stable angina pectoris (SAP). Thirty-six individuals with normal coronary artery served as the control group. Serum MRP8/14 and ECP were measured by ELISA. The severity of coronary artery stenosis was assessed by the numbers of involved coronary artery branches and the sum of Gensini scores. Results. The MRP8/14 levels were significantly higher in AMI and UAP group than SAP and control group (). The levels of MRP8/14 in AMI group were also obviously higher than UAP group (). The ECP levels were obviously increased in AMI group, but there was no difference between SAP and UAP group (). The ECP was significantly increased in three impaired coronary arteries and obviously correlated with Gensini score (), whereas the MRP8/14 was obviously positively correlated with CRP (). Conclusions. Increased MRP8/14 levels suggest the instability of the atherosclerotic plaque. ECP reflects the severity of coronary arteries stenosis, predicting atherosclerosis burden. They may become the new biomarkers of CAD.
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Introduction. The paper aims to evaluate the influence of two different demanding cognitive tasks on gait parameters using BTS SMART system analysis. Patients and Methods. The study comprised 53 postmenopausal women aged 64.5 ± 6.7 years (range: 47–79). For every subject, gait analysis using a BTS SMART system was performed in a dual-task study design under three conditions: (I) while walking only (single task), (II) walking while performing a simultaneous simple cognitive task (SCT) (dual task), and (III) walking while performing a simultaneous complex cognitive task (CCT) (dual task). Time-space parameters of gait pertaining to the length of a single support phase, double support phase, gait speed, step length, step width, and leg swing speed were analyzed. Results. Performance of cognitive tests during gait resulted in a statistically significant prolongation of the left (by 7%) and right (by 7%) foot gait cycle, shortening of the length of steps made with the right extremity (by 4%), reduction of speed of swings made with the left (by 11%) and right (by 8%) extremity, and reduction in gait speed (by 6%). Conclusions. Performance of cognitive tests during gait changes its individual pattern in relation to the level of the difficulty of the task.
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Purpose. To apply massage therapy accompanied with stretching exercises for treatment of mammary gland hyperplasia, evaluate the clinical outcome in patients, and estimate the therapy as a novel treatment method for mammary hyperplasia. Methods. 28 adult female patients were selected and treated with massage therapy and stretching exercises focusing on skeleton muscles of chest, abdomen, and axilla. The mammary gland oxyhemoglobin (OxyHb) and deoxyhemoglobin (DeoxyHb) levels were detected before and after treatment after 15, 30, and 45 days. Results. In this cohort, pretreatment OxyHb (mean ± SD) is (medium-high), and DeoxyHb is (normal). All patients were clinically diagnosed with benign mammary gland hyperplasia and mastitis. The posttreatment OxyHb levels are (normal-medium, 15-day), (normal, 30-day), and (normal, 45-day), and DeoxyHb levels are (normal, 15-day), (normal, 30-day), and (normal, 45-day). Patients were diagnosed with decreased hyperplasia 15 and 30 days after treatment and with no symptom of hyperplasia in mammary gland 45 days after treatment. Conclusion. Mammary gland hyperplasia is closely correlated with pathological changes of skeletal muscles and could be significantly improved by massage therapy and stretching exercises targeting neighboring skeletal muscles.
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Human immunodeficiency virus infection destroys the body immune system, increases the risk of certain pathologies, damages body organs such as the brain, kidney, and heart, and causes death. Unfortunately, this infectious disease currently has no cure; however, there are effective retroviral drugs for improving the patients' health conditions but excessive use of these drugs is not without harmful side effects. This study presents a mathematical model with two control variables, where the uninfected CD4+T cells follow the logistic growth function and the incidence term is saturated with free virions. We use the efficacy of drug therapies to block the infection of new cells and prevent the production of new free virions. Our aim is to apply optimal control approach to maximize the concentration of uninfected CD4+T cells in the body by using minimum drug therapies. We establish the existence of an optimal control pair and use Pontryagin's principle to characterize the optimal levels of the two controls. The resulting optimality system is solved numerically to obtain the optimal control pair. Finally, we discuss the numerical simulation results which confirm the effectiveness of the model.
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Publication date: Available online 28 February 2016
Source:Allergology International
Author(s): Naoto Kawakami
Intravital imaging is becoming more popular and is being used to visualize cellular motility and functions. In contrast to in vitro analysis, which resembles in vivo analysis, intravital imaging can be used to observe and analyze cells directly in vivo. In this review, I will summarize recent imaging studies of autoreactive T cell infiltration into the central nervous system (CNS) and provide technical background. During their in vivo journey, autoreactive T cells interact with many different cells. At first, autoreactive T cells interact with endothelial cells in the airways of the lung or with splenocytes, where they acquire a migratory phenotype to infiltrate into the CNS. After arriving at the CNS, they interact with endothelial cells of the leptomeningeal vessels or the choroid plexus before passing through the blood–brain barrier. CNS-infiltrating T cells become activated by recognizing endogenous autoantigens presented by local antigen-presenting cells (APCs). This activation was visualized in vivo by using protein-based sensors. One such sensor detects changes in intracellular calcium concentration as an early marker of T cell activation. Another sensor detects translocation of Nuclear factor of activated T-cells (NFAT) from cytosol to nucleus as a definitive sign of T cell activation. Importantly, intravital imaging is not just used to visualize cellular behavior. Together with precise analysis, intravital imaging deepens our knowledge of cellular functions in living organs and also provides a platform for developing therapeutic treatments.
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Publication date: Available online 28 February 2016
Source:Allergology International
Author(s): Shigeyuki Narabayashi, Ikuo Okafuji, Yuya Tanaka, Satoru Tsuruta, Nobue Takamatsu
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Publication date: Available online 27 February 2016
Source:Molecular and Cellular Endocrinology
Author(s): G. Lucena, C. Reyes-Botella, O. García-Martínez, J. Ramos-Torrecillas, E. De Luna Bertos, C. Ruiz
Aminopeptidases (APs) are involved in various physiological and pathological processes. In tumor tissues the expression of APs, cyclooxygenase-2 and its metabolites are increased. The objective was to determine the effect of certain NSAIDs on the AP activity of osteoblasts. Primary cultures of osteoblast were treated with different concentrations of indomethacin, meloxicam, naproxen, nimesulide, and piroxicam. The AP activity was fluorimetrically determined using aminoacyl-β-naphthylamides (aa-βNAs) as substrates: Ala-βNA, Arg-βNA, Gly-βNA, Leu-βNA, Lys-βNA, Met-βNA, and Phe-βNA.The five NSAIDs showed an inhibitory effect of AP activity against the study substrates depending on the dose tested. Meloxicam and piroxicam had the highest inhibitory effect on enzymatic activity, with an IC50 of around 70 μM. Our results suggest that the physiological alteration of osteoblasts in the presence of NSAIDs may be a consequence of AP inhibition, suggesting a potential clinical role for these drugs against cancer in combination with chemotherapeutic agents.
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OBJECTIVE: Crescent literature data demonstrated a role of adipokines in immune responses, particularly leptin is involved in wide spectrum of pro-inflammatory functions. Several evidences suggested that leptin is able to inhibit T regulatory cells proliferation and function in vitro models. In the present study, we investigate the relationship between leptin and circulating T regulatory cells (Tregs) in patients affected by systemic lupus erythematosus (SLE).
PATIENTS AND METHODS: 13 SLE patients and 11 healthy controls were enrolled. Metabolic syndrome and cardiovascular parameters were evaluated. Serum leptin levels were detected by commercial ELISA kit and circulating regulatory T cells were determined by FACS analysis as CD4+CD25highFOP3+ lymphocytes.
RESULTS: Metabolic syndrome, defined by ATPIII criteria, was more prevalent in SLE compared to controls (38.4% vs. 0%, p = 0.04), as well as arterial hypertension (38.4% vs. 0%, p = 0.04). We did not find significant differences in mean leptin levels among SLE and controls (13.13±1.51 ng/ml vs. 9.48±8.67 ng/ml, p = 0.6). Mean Tregs percentage of total CD4 were 1.27±0.9 in SLE vs. 2.8±1.2 in healthy controls (p = 0.001). We found a negative correlation between leptin levels and Tregs percentage of total CD4 in SLE patients (r = 0.4, p = 0.01).
CONCLUSIONS: Our results, suggest a role of leptin in the regulation of circulating T regulatory cells amount in human SLE.
L'articolo Relationship between leptin and regulatory T cells in systemic lupus erythematosus: preliminary results sembra essere il primo su European Review.
OBJECTIVE: Accumulated data have indicated that bilirubin has antiinflammatory, antioxidative, and immunosuppressive properties. Polymyositis (PM) belongs to an autoimmune disease characterized by chronic inflammation in skeletal muscle. Until now, to the best of our knowledge, there are no literature investigating bilirubin levels in patients with PM. Therefore, the aim of this investigation was to assess a relationship between bilirubin and PM.
PATIENTS AND METHODS: Our study included newly diagnosed 77 patients with PM who were admitted to the Affiliated Hospital of Youjiang Medical University for Nationalities (Guangxi, China) and 108 healthy subjects as controls. Clinical characteristics and laboratory parameters of patients were analyzed, retrospectively.
RESULTS: The serum concentrations of total bilirubin (TB), conjugate bilirubin (CB), unconjugated bilirubin (UCB) were significantly lower in patients with PM than healthy controls. Serum concentrations of TB were negatively correlated with erythrocyte sedimentation rate (ESR), creatine kinase (CK) and lactic dehydrogenase (LDH) in patients with PM (r=-0.494, p＜0.001; r=-0.274, p=0.017; r=-0.282, p=0.014), and serum concentrations of UCB were negatively correlated with ESR and CK in PM patients (r=-0.424, p＜0.001; r=-0.234, p=0.041). Both serum TB and UBC concentrations were positively correlated with manual muscle test (MMT) score in patients with PM (r=0.328, p=0.004; r=0.333, p=0.004). In multiple linear regression analysis, serum UBC levels were independently associated with MMT score (r=0.239, p=0.003).
CONCLUSIONS: We observed significantly lower serum concentrations of TB, CB and UCB in patients with PM, and suggested a potential association between serum concentrations of UBC and disease activity in PM patients.
L'articolo A potential clinical usefulness of measuring serum bilirubin levels in patients with polymyositis sembra essere il primo su European Review.
Publication date: 14 March 2016
Source:Vaccine, Volume 34, Issue 12
Author(s): Lars Ostergaard, Gregg H. Lucksinger, Judith Absalon, Johannes Beeslaar, Joseph Eiden, Kathrin U. Jansen, Laura J. York, Angela Quinn, Mette E. Graversen, John L. Perez
BackgroundNeisseria meningitidis serogroup B (MnB) is an important cause of invasive meningococcal disease (IMD). A MnB vaccine (bivalent rLP2086, Trumenba®) consisting of 2 factor H binding protein variants received accelerated approval in the United States for the prevention of IMD caused by MnB in individuals 10–25 years of age. This randomized, active-controlled, observer-blind study further assessed the safety and tolerability of bivalent rLP2086.MethodsEligible subjects ≥10 to <26 years were randomized (2:1) to receive bivalent rLP2086 at months 0, 2, and 6, or hepatitis A virus vaccine (HAV, Havrix®) at months 0 and 6, and saline at month 2. The primary endpoints were serious adverse events (SAEs) throughout the study and medically-attended adverse events (MAEs) within 30 days after vaccination. Additional safety assessments included SAEs at other study intervals and adverse events (AEs) during the vaccination phase.ResultsOf 5712 subjects randomized, 84.6% (n=3219) of bivalent rLP2086 recipients and 87.2% (n=1663) of HAV/saline recipients completed the study. Throughout the study, SAEs were reported for 1.6% and 2.5% of bivalent rLP2086 and HAV/saline recipients, respectively. SAEs related to either vaccine were rare. MAEs occurred in 7.0% and 6.1% of subjects after vaccination 1; 5.5% and 6.1% after vaccination 2; and 5.3% and 5.5% after vaccination 3 in the bivalent rLP2086 and HAV/saline groups, respectively. A greater proportion of subjects reported AEs during the vaccination phase after bivalent rLP2086 compared with HAV/saline recipients; however, when reactogenicity events were excluded, the proportion between groups was similar.ConclusionThis safety study, the largest randomized, active-controlled trial evaluating a recombinant MnB vaccine, demonstrated that bivalent rLP2086 is safe and tolerable in healthy individuals ≥10 to <26 years of age.
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Publication date: Available online 27 February 2016
Source:Vaccine
Author(s): Hayley A. Hutchings, Annette Evans, Peter Barnes, Melanie A. Healy, Michelle James-Ellison, Ronan A. Lyons, Alison Maddocks, Shantini Paranjothy, Sarah E. Rodgers, Frank Dunstan
BackgroundThere are conflicting findings regarding the impact of residential mobility on immunisation status. Our aim was to determine whether there was any association between residential mobility and take up of immunisations and whether they were delayed in administration.MethodsWe carried out a cohort analysis of children born in Wales, UK. Uptake and time of immunisation were collected electronically. We defined frequent movers as those who had moved: 2 or more times in the period prior to the final scheduled on-time date (4 months) for 5 in 1 vaccinations; and 3 or more times in the period prior to the final scheduled on-time date (12 months) for MMR, pneumococcal and meningitis C vaccinations. We defined immunisations due at 2–4 months delayed if they had not been given by age 1; and those due at 12–13 months as delayed if they had not been given by age 2.ResultsUptake rates of routine immunisations and whether they were given within the specified timeframe were high for both groups. There was no increased risk (odds ratios (95% confidence intervals) between frequent movers compared to non-movers for the uptake of: primary MMR 1.08 (0.88–1.32); booster Meningitis C 1.65 (0.93–2.92); booster pneumococcal 1.60 (0.59–4.31); primary 5 in 1 1.28 (0.92–1.78); and timeliness: primary MMR 0.92 (0.79–1.07); booster Meningitis C 1.26 (0.77–2.07); booster pneumococcal 1.69 (0.23–12.14); and primary 5 in 1 1.04 (0.88–1.23).DiscussionFindings suggest that children who move home frequently are not adversely affected in terms of the uptake of immunisations and whether they were given within a specified timeframe. Both were high and may reflect proactive behaviour in the primary healthcare setting to meet Government coverage rates for immunisation.
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OBJECTIVE: To investigate the influence of procyanidins on the impairment of memory.
MATERIALS AND METHODS: Thirty male C57bl/6 mice were divided into five groups: low, middle, and high concentration, model, and control groups. Intracerebroventricular injection of β-amyloid25-35 in C57bl/6 mice caused an impairment of learning and memory. Next day, intragastric administration of procyanidins in the treatment group mice: (lower, middle and high concentration). Hoechst staining observed apoptosis of neuronal nuclei in the hippocampus. Immunohistochemistry determined synaptic remodeling reaction and the expression level of glial inflammatory response.
RESULTS: Compared with the model group, the proportion of neuronal apoptosis decreased in the hippocampal CA1 region of the treatment group. The Synaptic (SYN) density was increased, and the level of activated astrocytes and microglia expression in the hippocampus was decreased.
CONCLUSIONS: Procyanidins have a protective influence on Aβ25-35 mice hippocampus neuron, reducing nerve cell damage and eases learning and memory deficit.
L'articolo Proanthocyanidins affects the neurotoxicity of Aβ25-35 on C57/bl6 mice sembra essere il primo su European Review.
OBJECTIVE: The prevalence of hemorrhagic transformation (HT) after acute ischemic infarction varies greatly. Risk factors of HT include ageing, severity of stroke, baseline hypertension, high NIH Stroke Scale (NIHSS) scores, hyperglycemia and cardioembolic infarction and low levels of low-density lipoprotein (LDL). We investigated the relationship between LDL, lipid profile and HT after acute ischemic infarction and suggested precautions for HT management.
PATIENTS AND METHODS: Three hundred and forty-eight patients with acute infarction were included in the study. Fasting lipid profile was examined on the next morning following hospitalization. Either MRI GRE-T2*WI or CT was performed, one week after hospitalization to detect any cerebral microbleed (CMB) and hemorrhagic transformation. The lipid profiles examined included total cholesterol (TCH), triglyceride (TG), LDL and high-density lipoprotein (HDL).
RESULTS: Among all the patients, HT was noted in 35 patients and non-HT in 313. As compared with non-HT group, HT group had lower levels of TCH, HDL and LDL, lower rates of leukoaraiosis and CMB, but higher scores of NIHSS, higher rates of diabetes mellitus, atrial fibrillation and urokinase thrombolysis. The multivariate binary logistic regression showed that cardioembolic infarction, infarction with undetermined etiology, high scores of NIHSS and diabetes were the risk factors of HT, while the protective factor was LDL (OR=0.654, 95% CI: 0.430-0.996, p=0.048).
CONCLUSIONS: Low level of LDL is likely associated with increased HT after acute ischemic infarct, so for those patients with low level of LDL, high scores of NIHSS and cardioembolic infarction at admission, aggressive lipid- lowering treatment should be prescribed cautiously to prevent the incidence of HT.
L'articolo Low level of low-density lipoprotein cholesterol is related with increased hemorrhagic transformation after acute ischemic cerebral infarction sembra essere il primo su European Review.
| Related Articles |
[Changes in the publication of Neurocirugía].
Neurocirugia (Astur). 2016 Jan-Feb;27(1):1
Authors: Lagares A, Fernández Alén JA, Comité de Redacción
PMID: 26915752 [PubMed - in process]
OBJECTIVE: Breast cancer (BC) is one of the most common malignant tumors occurred in women. There is no sensitive and specific marker for early diagnosis, treatment and prognosis of breast cancer. It is suggested that miRNA may be a potential tumor marker for breast cancer. Mir-520g is considered to be associated with many tumors. This study aims to test the expression of mir-520g in peripheral blood of BC patients and healthy control. We also explored the relationship between mir-520g and several prognostic factors in breast cancer patients.
PATIENTS AND METHODS: The peripheral blood of 86 cases with breast cancer (including 18 cases with stage 0, 24 cases of phase I, 20 cases of stage II, 24 cases of stage III) and 26 cases of healthy subjects were collected. The miR-520g level was measured by real-time quantitative PCR (RT qPCR) method. The correlation between plasma miR-520g level and the clinical stage, molecular subtype, receptors' expression and other factors related to the prognosis of the patients were examined.
RESULTS: Plasma mir-520g expression levels were significantly higher in BC patients with lymph node metastatic and low differentiation degree grade (p = 0.033 and 0.016), and plasma miR-520g expression was significantly higher in breast cancer patients with mammary gland invasion (p < 0.01) and low expressed p53 (p = 0.0039).
CONCLUSIONS: Highly expressed mir-520g is associated with lymph node metastasis and low differentiation of breast cancer, and also is associated with mammary gland invasion in breast cancer. This study suggests that mir-520g may be associated with some important prognostic factors in breast cancer patients, and may have a potential value for breast cancer marker.
L'articolo Study on the relationship between miR-520g and the development of breast cancer sembra essere il primo su European Review.
OBJECTIVE: Bladder cancer (BCa) is the most common malignancy of the urinary tract. In this study, we aimed to evaluate the ability of preoperative neutrophil-to-lymphocyte ratio (NLR) to predict pathologic stage of at the time of first transurethral resection of bladder tumor (TUR-BT) in patients with BCa larger than 3 cm.
PATIENTS AND METHODS: Records of consecutive patients undergoing TUR-BT for BCa with a diameter >3 cm were reviewed. A total of 222 patients were eligible for analysis, and were divided into two groups: 162 patients in non-muscle-invasive BCa (NMIBC) group and 60 patients in muscle-invasive BCa (MIBC) group. Differences in preoperative blood parameters and NLR were evaluated between groups with an unequal variance t-test.
RESULTS: In the NMIBC group, 59 patients had low-grade and 103 high-grade papillary urothelial carcinomas. 60 patients had T2 stage carcinoma. The mean age of the patients was 71.8 and 75.7 years, and mean NLR was 3.44 ± 2.03 and 4.6 ± 2.8 in NMIBC and MIBC groups, respectively. In terms of NLR, there was a statistically significant difference between the NMIBC and MIBC groups (p = 0.005).
CONCLUSIONS: Our results showed that NLR might act as a significant predictive biomarker on the staging of BCa. Also, NLR could be used as a cost-effective, simple, common usable biomarker in urology clinic practice.
L'articolo Preoperative neutrophil-to-lymphocyte ratio (NLR) may be predictive of pathologic stage in patients with bladder cancer larger than 3 cm sembra essere il primo su European Review.
OBJECTIVE: To compare the different expressions of CD27, CD28, IL-17A, IFN-γ and TNF-α in the peripheral blood sampled from patients with colorectal carcinoma and healthy volunteers.
PATIENTS AND METHODS: Vδ2 T cells were isolated from the peripheral blood mononuclear cells (PBMCs) of patients with the colorectal carcinoma (CRC, n = 30) and healthy controls (HC, n = 21). The proportion of CD27, CD28, IL-17A, IFN-γ and TNF-α of Vδ2 T cells was detected by the flow cytometry.
RESULTS: We found that the proportion of IL-17A of Vδ2 T cells in PBMCs was higher in the CRC vs. the HC group (p < 0.05). A significant positive correlation was observed between the expression of IFN-γ and TNF-α of Vδ2 T cells. In the CRC patients, the proportions of IL-17A of CD27- Vδ2 T cells and CD28+ Vδ2 T cells were higher than those of CD27+ Vδ2 T cells and CD28- Vδ2 T cells, whereas the expression of IFN-γ and TNF-α of CD27-Vδ2 T cells was lower than that of CD27+ Vδ2 T cells.
CONCLUSIONS: Vδ2 T cells from PBMCs had higher expression of IL-17A in CRC patients than that in the HC group. The expression of IFN-γ and TNF-α of Vδ2 T cells from PBMCs was positively correlated. The cytokine profiles of peripheral Vδ2 T cells were likely determined by a CD27 and CD28 involving mechanism.
L'articolo Expression of CD27, CD28 and IL-17A in peripheral blood from patients with colorectal carcinoma sembra essere il primo su European Review.
OBJECTIVE: Crescent literature data demonstrated a role of adipokines in immune responses, particularly leptin is involved in wide spectrum of pro-inflammatory functions. Several evidences suggested that leptin is able to inhibit T regulatory cells proliferation and function in vitro models. In the present study, we investigate the relationship between leptin and circulating T regulatory cells (Tregs) in patients affected by systemic lupus erythematosus (SLE).
PATIENTS AND METHODS: 13 SLE patients and 11 healthy controls were enrolled. Metabolic syndrome and cardiovascular parameters were evaluated. Serum leptin levels were detected by commercial ELISA kit and circulating regulatory T cells were determined by FACS analysis as CD4+CD25highFOP3+ lymphocytes.
RESULTS: Metabolic syndrome, defined by ATPIII criteria, was more prevalent in SLE compared to controls (38.4% vs. 0%, p = 0.04), as well as arterial hypertension (38.4% vs. 0%, p = 0.04). We did not find significant differences in mean leptin levels among SLE and controls (13.13±1.51 ng/ml vs. 9.48±8.67 ng/ml, p = 0.6). Mean Tregs percentage of total CD4 were 1.27±0.9 in SLE vs. 2.8±1.2 in healthy controls (p = 0.001). We found a negative correlation between leptin levels and Tregs percentage of total CD4 in SLE patients (r = 0.4, p = 0.01).
CONCLUSIONS: Our results, suggest a role of leptin in the regulation of circulating T regulatory cells amount in human SLE.
L'articolo Relationship between leptin and regulatory T cells in systemic lupus erythematosus: preliminary results sembra essere il primo su European Review.
OBJECTIVE: Accumulated data have indicated that bilirubin has antiinflammatory, antioxidative, and immunosuppressive properties. Polymyositis (PM) belongs to an autoimmune disease characterized by chronic inflammation in skeletal muscle. Until now, to the best of our knowledge, there are no literature investigating bilirubin levels in patients with PM. Therefore, the aim of this investigation was to assess a relationship between bilirubin and PM.
PATIENTS AND METHODS: Our study included newly diagnosed 77 patients with PM who were admitted to the Affiliated Hospital of Youjiang Medical University for Nationalities (Guangxi, China) and 108 healthy subjects as controls. Clinical characteristics and laboratory parameters of patients were analyzed, retrospectively.
RESULTS: The serum concentrations of total bilirubin (TB), conjugate bilirubin (CB), unconjugated bilirubin (UCB) were significantly lower in patients with PM than healthy controls. Serum concentrations of TB were negatively correlated with erythrocyte sedimentation rate (ESR), creatine kinase (CK) and lactic dehydrogenase (LDH) in patients with PM (r=-0.494, p＜0.001; r=-0.274, p=0.017; r=-0.282, p=0.014), and serum concentrations of UCB were negatively correlated with ESR and CK in PM patients (r=-0.424, p＜0.001; r=-0.234, p=0.041). Both serum TB and UBC concentrations were positively correlated with manual muscle test (MMT) score in patients with PM (r=0.328, p=0.004; r=0.333, p=0.004). In multiple linear regression analysis, serum UBC levels were independently associated with MMT score (r=0.239, p=0.003).
CONCLUSIONS: We observed significantly lower serum concentrations of TB, CB and UCB in patients with PM, and suggested a potential association between serum concentrations of UBC and disease activity in PM patients.
L'articolo A potential clinical usefulness of measuring serum bilirubin levels in patients with polymyositis sembra essere il primo su European Review.
OBJECTIVE: Optimal hemodynamic resuscitation strategy of the trauma patient with uncontrolled hemorrhage and severe head injury in the pre-hospital setting remains a special challenge. Permissive hypotension prior to definite surgical haemostasis promotes coagulation, decreases blood loss and favors survival. However, hypotension is associated with poor outcome in severe head injury. The purpose of this experimental animal study was to assess the impact of permissive hypotension on survival, hemodynamic profile and brain oxygenation parameters before and/or after definite surgical haemostasis.
PATIENTS AND METHODS: Six-week-old pigs (n=12) underwent general anesthesia and brain injury was produced by the fluid percussion model. Animals were instrumented to measure hemodynamic parameters and cerebral blood flow. All animals (n=12) were subjected to laparotomy and a surgical knot was placed through the abdominal aorta wall. Uncontrolled hemorrhage was simulated by pulling out the intentionally left protruding free ends of the suture (goal MAP=30 mmHg). Animals were randomly divided into two groups; group A (n=6) was subjected to aggressive fluid resuscitation (goal SAP >80 mmHg) and group B (n=6) was left hypotensive (permissive hypotension). Animals who survived one hour of hypotensive shock underwent definite surgical haemostasis and were resuscitated for one hour. We measured survival, hemodynamic and brain oxygenation parameters at different time points before and after surgical haemostasis.
RESULTS: All animals from Group A and 50% from Group B died before surgical haemostasis. In surviving animals (Group B, 50%, p=0.033), MAP, CO, rCBF, SjO2 and AVDO2 were restored to pre-procedural levels.
CONCLUSIONS: Permissive hypotension by delaying fluid resuscitation up to definite surgical haemostasis improves survival, hemodynamics and allows restoration of cerebral oxygenation in severe head injury.
L'articolo The effect of permissive hypotension in combined traumatic brain injury and blunt abdominal trauma: an experimental study in swines sembra essere il primo su European Review.
OBJECTIVE: To design a new Arg-Gly-Asp (RGD) peptide that can specifically bind integrin αvβ3 and evaluate the possibility of using 131I-labeled peptide for imaging αvβ3-positive tumors.
MATERIALS AND METHODS: The structure of the RGD monomer was selected using V-life software. Based on the RGD monomer, a dimer of cyclic RGD [c(RGD)2] linked by Tyr-(D)Ser-Lys-(D)Ser-Ser with a Gly-Gly-(D)Ala-Gly side chain on the lysine residue was synthesized. 131I-c(RGD)2 was synthesized using the chloramine-T (ChT) method, and the octanol-water partition coefficient was experimentally measured. To evaluate its binding affinity and selectivity, its equilibrium dissociation constant (Kd) with U87 MG glioma cells was measured in vitro, while whole body imaging and biodistribution were assessed in vivo in mice bearing U87 MG xenografts.
RESULTS: The optimal structure of the monomer was cyclic [-Cys-Arg-Gly-Asp-(D)Ser-Cys-]. The 131I-c(RGD)2 molecule exhibited good stability and was highly hydrophilic. The Kd value was (3.87 ± 0.05) × 10-9 M, suggesting a high αvβ3-binding affinity and specificity. The tumors were clearly visualized at 3 and 6 h post-injection. Biodistribution data of the 131I-c(RGD)2 molecule showed rapid clearance from the blood and predominant accumulation in the tumor and kidney. The tumor-to-normal tissue (T/NT) ratio increased over time. At 24 h post-injection, the tumor-to-liver, tumor-to-muscle, and tumor-to-blood ratios were 4.92, 4.29, and 5.00, respectively.
CONCLUSIONS: These results suggest that the 131I-c(RGD)2 molecule may serve as a promising tracer for the detection of αvβ3-positive tumors.
L'articolo A new cyclic RGD peptide dimer for integrin αvβ3 imaging sembra essere il primo su European Review.
OBJECTIVE: This study aims to explore the ocular surface of late stage eye burns by impression cytology (IC) and analyze the cytological changes and their relationship to ocular surface abnormalities.
PATIENTS AND METHODS: 68 eyes with late stage eye burns (thermal burn: 28 eyes; alkali burn: 26 eyes; acid burn: 14 eyes), procured from 68 patients (aged ranges from 17 to 70 years old). Ocular surface abnormalities were assessed under slit lamp and graded. These were broadly classified as eyelid, corneal, conjunctival, and tear film abnormalities. Impression cytological examination was taken by cellulose acetate filter paper for all eyes. Samples were analyzed and scored under light microscope, including the status of epithelial cells, goblet cells, mucus and inflammatory cells. All the results and data were compared and analyzed by SPSS software (version 16.0).
RESULTS: According to the IC results, loosed cell-to-cell density and nuclear abnormality, keratinization, reduced goblet cell amount, disorder of mucus, and existing of inflammatory cells were observed in almost all the cases. The IC results were significantly correlated to the ocular surface injury severity (r=0.458, p<0.01). The ocular surface injury severity mostly contains three aspects: the corneal neovascularization scales, the present or absent of recurrent epithelial erosion and the tear film break-up time. Eyes with the foreword three symptoms were inclined to have higher IC scores. The epithelial cell-to-cell density, goblet cell and mucus amount were all correlated to tear film break-up time. However, inflammatory cell density showed no significant correlation to the conjunctival hyperemia grade. But inflammatory cell density correlated to the corneal opacity grade and epithelial stability status.
CONCLUSIONS: IC examinations could reflect the cytological disorders and relative injury severity of the ocular surface in late stage eye burns. It provides further information which will be useful in surgery and therapy.
L'articolo Impression cytological study for ocular surface disorders of late stage eye burns sembra essere il primo su European Review.
OBJECTIVE: The hypo-osmotic swelling (HOS) test predicts membrane integrity by determining the ability of the sperm membrane to maintain equilibrium between the sperm cell and its environment. The aim of our study was to determine the correlation between selenium and carnitine levels in the seminal fluid with HOS test for sperm membrane in low-grade varicocele patients.
PATIENTS AND METHODS: Study numbered 64 examinees who suffered from low-grade varicocele and were divided into two groups, according to fertility potential and HOS test outcome. The study also included a control group of 64 healthy subjects, with no varicocele.
RESULTS: From the Shapiro-Wilk's test, it is clear that carnitine distribution differs significantly from normal (0.938, p = 0.03). In distribution of selenium, Kolmogorov-Smirnov test clearly shows statistically significant deviation from the normal curve (z = 0.225, p < 0.000), likewise Shapiro-Wilk's statistic (0.787, p < 0.000). According to the results, the second group had significantly higher levels of carnitine and selenium than the first group of examinees (p < 0.05); therefore, when we compared epididymal markers with HOS tests outcomes, we found significant differences between the two groups. There were no significant differences between second group and healthy subjects (p > 0.05).
CONCLUSIONS: HOS test outcome in varicocele patients is directly proportional to the carnitine and selenium levels, which could play a major role in both determining fertility parameters and in the treatment of its impairment. This result is especially important for sub-clinical varicocele in infertile patients with normal semen analysis, since there is no evidence of benefit from any treatment so far.
L'articolo A correlation between selenium and carnitine levels with Hypo-osmotic swelling test for sperm membrane in low-grade varicocele patients sembra essere il primo su European Review.
OBJECTIVE: To evaluate the effect of temporary complete hilar versus only renal artery clamping with different duration of warm ischemia on renal functions, and possibly identify a "safe" clamping type and duration of renal ischemia.
MATERIALS AND METHODS: Fifty male rabbits have been incorporated to study. Rabbits were subjected to ischemia/reperfusion injury by temporary vascular clamping. Reagents were randomized to 3 experimental groups (only renal artery clamping, complete hilar clamping, sham surgery) and sub-groups were determined according to different clamping times (30 and 60 minutes). Median laparotomy and left renal hilus dissection were performed to sham group. Only artery or complete hilar clamping was performed for 30 or 60 minutes by microvascular bulldog clamps to other reagents. Rabbits were sacrificed 10 days after primary surgery and left nephrectomy performed. Nephrectomy materials were evaluated for the level of nitric-oxide synthase (NOS) immunoreactivity, malondialdehyde (MDA) level and superoxide dismutase (SOD) activity and an electron microscopic examination was performed.
RESULTS: NOS immunoreactivity was correlated with the temporary clamping time. We also observed that complete hilar vascular clamping entails an increase on NOS immunoreactivity. MDA levels were similar for all experimental surgery groups (p = 0.42). The SOD activity was decreased among all subgroups compared with sham surgery. But the significant decrease occurred in 30 minutes only artery and 30 minutes complete hilar clamping groups in proportion to sham surgery (p = 0.026 and p = 0.019, respectively).
CONCLUSIONS: This current study suggested that only renal artery clamping under 30 minutes is more appropriate during renal surgical procedures requiring temporary vascular clamping.
L'articolo Effect of complete hilar versus only renal artery clamping on renal histomorphology following ischemia/reperfusion injury in an experimental model sembra essere il primo su European Review.
Publication date: Available online 27 February 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Tadahiro Kamiya, Keisuke Uehara, Goro Nakayama, Kiyoshi Ishigure, Satoshi Kobayashi, Kazuhiro Hiramatsu, Hiroshi Nakayama, Katsuya Yamashita, Eiji Sakamoto, Yuichiro Tojima, Satoru Kawai, Yasuhiro Kodera, Masato Nagino
Backgrounds: Perioperative introduction of developed chemotherapy into the treatment strategy for locally advanced rectal cancer (LARC) may be a promising option. However, the most prevalent treatment for high-risk LARC remains preoperative chemoradiotherapy (CRT) in Western countries.Patients and methodsA phase II trial was undertaken to evaluate safety and efficacy of perioperative XELOX without radiotherapy (RT) for patients with high-risk LARC. Patients received 4 cycles of XELOX before and after surgery, respectively. Primary endpoint was disease-free survival.ResultsWe enrolled 41 patients between June 2012 and April 2014. The completion rate of the preoperative XELOX was 90.3%. Twenty-nine patients (70.7%) could start postoperative XELOX, 15 of these patients (51.7%) completed 4 cycles. Allergic reaction to oxaliplatin was experienced by 5 patients (17.2%) during postoperative XELOX. One patient received additional RT after preoperative XELOX. Consequently, the remaining 40 patients underwent primary resection. Major complications occurred in 6 of 40 patients (15.0%). Pathological complete response (pCR) rate was 12.2%, and good tumor regression was exhibited in 31.7%. N down-staging (cN+ to ypN0) and T down-staging were detected in 56.7% and 52.5%, respectively. Clinical T4 tumor was a predictor of poor pathological response (p<0.001).ConclusionsWe could show the favorable pCR rate after preoperative XELOX alone. However, the T and N down-staging rate was likely to be insufficient. When tumor regression is essential for curative resection, the use of preoperative CRT is likely to be recommended. For patients with massive LN metastasis, the additional Bev to NAC might be a promising option.
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Publication date: Available online 27 February 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Simon P. Barr, Ashley R. Topps, Nicola L.P. Barnes, Julia Henderson, Sue Hignett, Rebecca Teasdalea, Adrian McKenna, James R. Harvey, Cliona C. Kirwan
IntroductionAs a result of increasing use of implant-based breast reconstruction, complications such as infection are being encountered more frequently. Surgical Site Infections (SSIs) cause morbidity for the patient, can lead to capsular contracture or implant loss and are costly to healthcare systems. National Guidelines suggesting methods to reduce SSI related complications have been produced, but are limited in the scope of interventions covered and underlying evidence presented.MethodsWe performed a literature review encompassing a wide variety of possible SSI prevention strategies. We aimed to present summaries of the available evidence and give pragmatic recommendations as to their validity to use as guidelines for infection prevention strategies for implant-based breast reconstruction.ResultsA lack of high quality data relating to the benefit of SSI prevention strategies in implant-based breast reconstruction exists. Many papers relate to orthopaedic implant surgery, or clean surgery in general. Following review of the evidence, sufficient data exists to support use of perioperative antibiotics at implant-based breast reconstruction, with continuation for an extended period in "high risk" patients. Alcohol containing skin preparations should be used over aqueous solutions. Laminar airflow use is suggested. Theatre traffic should be kept to a minimum, as should duration of operative procedure. The implant pocket should be washed prior to implantation. Double gloving and conductive warming are also endorsed.ConclusionsWe have produced a perioperative "Theatre Implant Checklist" for SSI prevention in implant-based breast surgery, with a set of pragmatic up to date guidelines, which allows the reader to evaluate the evidence upon which our recommendations are based.
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Publication date: Available online 27 February 2016
Source:Best Practice & Research Clinical Endocrinology & Metabolism
Author(s): Martin Cuesta, C.J. Thompson
Hyponatraemia is the commonest electrolyte disturbance encountered in clinical practice and the syndrome of inappropriate antidiuresis (SIADH) is the most frequent underlying disorder. There is a well-recognized relationship between hyponatraemia and increased morbidity and mortality, though it is unknown whether SIADH confers the same mortality as other causes of hyponatraemia. SIADH is the biochemical manifestation of a wide variety of diseases, and the pathophysiology of SIADH is sometimes multiple. There have been significant advances in the treatment of SIADH over the last 10 years, in particular since the introduction of the vasopressin-2 receptor antagonists, which provide a potent, disease-specific tool which targets the underlying pathophysiology of SIADH. The mechanisms and the evidence base recommendations of the available therapies for SIADH are discussed in this article. The various guidelines and recommendations for treatment of hyponatraemia all emphasise that fluid restriction is first line therapy for SIADH, but we feel that it is ineffective or unfeasible in many patients. A number of key points relevant to the use of fluid restriction are presented in the manuscript. The clinical efficacy of tolvaptan in SIADH supported by good quality randomized, placebo controlled, clinical trials. However, the cost of the therapy and the need for long term safety data may limit its widespread use. Finally, new recommendations for the management of acute hyponatraemia, with a focus on the use of bolus therapy with 3% hypertonic sodium chloride is described.
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Publication date: Available online 27 February 2016
Source:Best Practice & Research Clinical Endocrinology & Metabolism
Author(s): Elizabeth Dabrowski, Rachel Kadakia, Donald Zimmerman
Diabetes insipidus, the inability to concentrate urine resulting in polyuria and polydipsia, can have different manifestations and management considerations in infants and children compared to adults. Central diabetes insipidus, secondary to lack of vasopressin production, is more common in children than is nephrogenic diabetes insipidus, the inability to respond appropriately to vasopressin. The goal of treatment in both forms of diabetes insipidus is to decrease urine output and thirst while allowing for appropriate fluid balance, normonatremia and ensuring an acceptable quality of life for each patient. An infant's obligate need to consume calories as liquid and the need for readjustment of medication dosing in growing children both present unique challenges for diabetes insipidus management in the pediatric population. Treatment modalities typically include vasopressin or thiazide diuretics. Special consideration must be given when managing diabetes insipidus in the adipsic patient, post-surgical patient, and in those undergoing chemotherapy or receiving medications that alter free water clearance.
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[Changes in the publication of Neurocirugía].
Neurocirugia (Astur). 2016 Jan-Feb;27(1):1
Authors: Lagares A, Fernández Alén JA, Comité de Redacción
PMID: 26915752 [PubMed - in process]
