MAGnesium-oral supplementation to reduce PAin in patients with severe PERipheral arterial occlusive disease: the MAG-PAPER randomised clinical trial protocol

Introduction

Magnesium exerts analgaesic effects in several animal pain models, as well as in patients affected by acute postoperative pain and neuropathic chronic pain. There is no evidence that magnesium can modulate pain in patients with peripheral arterial occlusive disease (PAOD). We describe the protocol of a single-centre randomised double-blind clinical trial aimed at assessing the efficacy of oral magnesium supplementation in controlling severe pain in patients with advanced PAOD.

Methods and analysis

Adult patients affected by PAOD at stages III and IV of Lèriche-Fontaine classification, who are opioid-naïve, and who have been admitted to our Acute Pain Service for intractable pain, will be eligible. Patients will be randomised to the control group, treated with standard therapy (oxycodone and pregabalin) plus placebo for 2 weeks, or to the experimental group (standard therapy plus magnesium oxide). Patients will be evaluated on days 0, 2, 4, 6, 8, 12 and 14; the following information will being collected: daily oxycodone dose; average and maximum pain (Numerical Rating Scale); pain relief (Pain Relief Scale); characteristics of the pain (Neuropathic Pain Scale); impact of pain on the patient's daily activities (Brief Pain Inventory). The primary outcome will be oxycodone dosage needed to achieve satisfactory analgaesia on day 14. Secondary outcomes will be pain relief on day 2, time needed to achieve satisfactory analgaesia and time needed to achieve a pain reduction of 50%. A sample size calculation was performed for the primary outcome, which estimated a required sample size of 150 patients (75 per group).

Ethics and dissemination

Ethical approval of the study protocol has been obtained from Comitato Etico Provinciale di Brescia, Brescia, Italy. Trial results will be disseminated through scientific journal manuscripts and scientific conference presentations.

Trial registration number

NCT02455726.

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Exercise Programme in Endometrial Cancer; Protocol of the Feasibility and Acceptability Survivorship Trial (EPEC-FAST)

Introduction

Obesity has been associated with impaired quality of life and poorer outcomes in endometrial cancer survivors. Lifestyle interventions promoting exercise and weight reduction have been proposed for survivorship care. However, studies evaluating exercise programmes for endometrial cancer survivors are lacking.

Purpose

The objective of this study is to evaluate the feasibility of an individualised exercise intervention for endometrial cancer survivors to improve quality of life.

Methods and analysis

This is a feasibility study in which women will undergo a 10-week exercise programme with a personal trainer. The study population comprises women with confirmed diagnosis of endometrial cancer, who have completed surgical treatment with curative intent, and are aged 18 years or older. The study will take place at the Royal Cornwall Hospital Trust, UK. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes are quality of life, psychological distress, fatigue, pain and complication rates. In addition, the acceptability of the programme will be assessed.

Ethics and dissemination

Ethical approval was obtained through the Exeter NRES Committee. The study results will be used to optimise the intervention content, and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses, relevant clinical groups and presented on the Trust's website.

Trial registration number:

NCT02367950; pre-results.

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VITALITY trial: protocol for a randomised controlled trial to establish the role of postnatal vitamin D supplementation in infant immune health

Introduction

Postnatal vitamin D supplementation may be associated with a reduction in IgE-mediated food allergy, lower respiratory tract infections and improved bone health. Countries in the Northern hemisphere recommend universal infant vitamin D supplementation to optimise early vitamin D levels, despite the absence of large trials proving safety or efficacy for any disease outcome. With the aim of determining the clinical and cost-effectiveness of daily vitamin D supplementation in breastfed infants from age 6–8 weeks to 12 months of age, we have started a double-blind, randomised, placebo-controlled trial of daily 400 IU vitamin D supplementation during the first year of life, VITALITY.

Methods nd analysis

Infants (n=3012) who are fully breastfed and not receiving vitamin D supplementation will be recruited at the time of their first immunisation, from council-led immunisation clinics throughout metropolitan Melbourne, Australia. The primary outcome is challenge-proven food allergy at 12 months of age. Secondary outcomes are food sensitisation (positive skin prick test), number of lower respiratory infections (through hospital linkage), moderately-severe and persistent eczema (by history and examination) and vitamin D deficiency (serum vitamin D <50 nmol/L) at age 12 months. The trial is underway and the first 130 participants have been recruited.

Ethics and dissemination

The VITALITY study is approved by the Royal Children's Hospital (RCH) Human Research Ethics Committee (#34168). Outcomes will be disseminated through publication and will be presented at scientific conferences.

Trial registration numbers

ANZCTR12614000334606 and NCT02112734; pre-results.

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Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink

Objectives

Little is known about service utilisation by patients with severe mental illness (SMI) in UK primary care. We examined their consultation rate patterns and whether they were impacted by the introduction of the Quality and Outcomes Framework (QOF), in 2004.

Design

Retrospective cohort study using individual patient data collected from 2000 to 2012.

Setting

627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database.

Participants

SMI cases (346 551) matched to 5 individuals without SMI (1 732 755) on age, gender and general practice.

Outcome measures

Consultation rates were calculated for both groups, across 3 types: face-to-face (primary outcome), telephone and other (not only consultations but including administrative tasks). Poisson regression analyses were used to identify predictors of consultation rates and calculate adjusted consultation rates. Interrupted time-series analysis was used to quantify the effect of the QOF.

Results

Over the study period, face-to-face consultations in primary care remained relatively stable in the matched control group (between 4.5 and 4.9 per annum) but increased for people with SMI (8.8–10.9). Women and older patients consulted more frequently in the SMI and the matched control groups, across all 3 consultation types. Following the introduction of the QOF, there was an increase in the annual trend of face-to-face consultation for people with SMI (average increase of 0.19 consultations per patient per year, 95% CI 0.02 to 0.36), which was not observed for the control group (estimates across groups statistically different, p=0.022).

Conclusions

The introduction of the QOF was associated with increases in the frequency of monitoring and in the average number of reported comorbidities for patients with SMI. This suggests that the QOF scheme successfully incentivised practices to improve their monitoring of the mental and physical health of this group of patients.

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Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system)

Purpose

The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events.

Participants

Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study (participation rate=90.2%).

Findings to date

Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men.

Future plans

Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration.

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Trends in serum creatinine testing in Oxfordshire, UK, 1993-2013: a population-based cohort study

Objectives

To determine how many kidney function tests are done, on whom, how frequently they are performed and how they have changed over time.

Design

Retrospective study of all serum creatinine, urine albumin and urine creatinine tests.

Setting

Primary and secondary care in Oxfordshire from 1993 to 2013.

Participants

Unselected population of 1 220 447 people.

Main outcome measures

The total number of creatinine and urinary protein tests ordered from primary and secondary care and the number of tests per year stratified by categories of estimated glomerular filtration rate (eGFR). The frequency of testing in patients having their kidney function monitored.

Results

Creatinine requests from primary care increased steadily from 1997 and exceeded 220 000 requests in 2013. Tests corresponding to normal kidney function (eGFR >60/mL/min/1.73 m2) constituted 59% of all kidney function tests in 1993 and accounted for 83% of all tests in 2013. Test corresponding to chronic kidney disease (CKD) stages 3–5 declined after 2007. Reduced kidney function, albuminuria, male gender, diabetes and age were independently associated with more frequent monitoring. For a female patient between 61 and 80 years and with stage 3a CKD, the average number of serum creatinine tests (95% CI) was 3.23/year (3.19 to 3.26) and for a similar woman with diabetes, the average number of tests was 5.50 (5.44 to 5.56) tests per year.

Conclusions

There has been a large increase in the number of kidney function tests over the past two decades. However, we found little evidence that this increase is detecting more CKD. Tests are becoming more frequent in people with and without evidence of renal impairment. Future work using a richer data source could help unravel the underlying reasons for the increased testing and determine how much is necessary and useful.

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Therapeutic management of complex anal fistulas by installing a nitinol closure clip: study protocol of a multicentric randomised controlled trial–FISCLOSE

Introduction

Complex anal fistulas are responsible for pain, faecal incontinence and impaired quality of life. The rectal mucosa advancement flap (RMAF) procedure to cover the internal opening of the fistula remains a strategy of choice. However, a new procedure for closing anal fistulas is now available with the use of a nitinol closure clip (OTSC Proctology, OVESCO), which should ensure a better healing rate. This procedure is currently becoming more widespread, though without robust scientific validation, and it is therefore essential to carry out a prospective evaluation in order to determine the efficacy and safety of this new medical device for complex anal fistulas.

Methods and analysis

The FISCLOSE trial is aimed at evaluating the efficacy and safety of a nitinol closure clip compared to the RMAF procedure for the management of complex anal fistulas. This trial is a prospective, randomised, controlled, single-blind, bicentre and interventional study. Patients (n=46 per group) will be randomly assigned for management with either a closure clip or RMAF. The main objectives are to improve the healing rate of the anal fistula, lessen the postoperative pain and faecal incontinency, enhance the quality of life, and lower the number of reinterventions and therapeutic management costs. The primary outcome is the proportion of patients with a healed fistula at 3 months. The secondary outcomes are anal fistula healing (6 and 12 months), proctological pain (visual analogue scale), the faecal incontinence score (Jorge and Wexner questionnaire), digestive disorders and quality of life (Gastrointestinal Quality of Life Index and Euroqol EQ5D-3 L) up to 1 year.

Ethics and dissemination

The study was approved by an independent medical ethics committee 1 (IRB00008526, CPP Sud-Est 6, Clermont-Ferrand, France) and registered by the competent French authority (ANSM, Saint Denis, France). The results will be disseminated in a peer-reviewed journal and presented at international congresses.

Trial registration number

NCT02336867; pre-result.

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Impact of geography on the control of type 2 diabetes mellitus: a review of geocoded clinical data from general practice

Objective

To review the clinical data for people with diabetes mellitus with reference to their location and clinical care in a general practice in Australia.

Materials and methods

Patient data were extracted from a general practice in Western Australia. Iterative data-cleansing steps were taken. Data were grouped into Statistical Area level 1 (SA1), designated as the smallest geographical area associated with the Census of Population and Housing. The data were analysed to identify if SA1s with people aged 70 years and older, and with relatively high glycosylated haemoglobin (HbA1c) were significantly clustered, and whether this was associated with their medical consultation rate and treatment. The analysis included Cluster and Outlier Analysis using Moran's I test.

Results

The overall median age of the population was 70 years with more males than females, 53% and 47%, respectively. Older people (>70 years) with relatively high HbA1c comprised 9.3% of all people with diabetes in the sample, and were clustered around two 'hotspot' locations. These 111 patients do not attend the practice more or less often than people with diabetes living elsewhere in the practice (p=0.098). There was some evidence that they were more likely to be recorded as having consulted with regard to other chronic diseases. The average number of prescribed medicines over a 13-month time period, per person in the hotspots, was 4.6 compared with 5.1 in other locations (p=0.26). Their prescribed therapy was deemed to be consistent with the management of people with diabetes in other locations with reference to the relevant diabetes guidelines.

Conclusions

Older patients with relatively high HbA1c are clustered in two locations within the practice area. Their hyperglycaemia and ongoing cardiovascular risk indicates causes other than therapeutic inertia. The causes may be related to the social determinants of health, which are influenced by geography.

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Protocol for a mixed-methods longitudinal study to identify factors influencing return to work in the over 50s participating in the UK Work Programme: Supporting Older People into Employment (SOPIE)

Introduction

Increasing employment among older workers is a policy priority given the increase in life expectancy and the drop in labour force participation after the age of 50. Reasons for this drop are complex but include poor health, age discrimination, inadequate skills/qualifications and caring roles; however, limited evidence exists on how best to support this group back to work. The Work Programme is the UK Government's flagship policy to facilitate return to work (RTW) among those at risk of long-term unemployment. 'Supporting Older People Into Employment' (SOPIE) is a mixed-methods longitudinal study involving a collaboration between academics and a major Work Programme provider (Ingeus). The study will investigate the relationship between health, worklessness and the RTW process for the over 50s.

Methods and analysis

There are three main study components. Embedded fieldwork will document the data routinely collected by Ingeus and the key interventions/activities delivered. The quantitative study investigates approximately 14 000 individuals (aged 16–64 years, with 20% aged over 50) who entered the Ingeus Work Programme (referred to as 'clients') in a 16-month period in Scotland and were followed up for 2 years. Employment outcomes (including progression towards work) and how they differ by client characteristics (including health), intervention components received and external factors will be investigated. The qualitative component will explore the experiences of clients and Ingeus staff, to better understand the interactions between health and (un)employment, Work Programme delivery, and how employment services can be better tailored to the needs of the over 50s.

Ethics and dissemination

Ethical approval was received from the University of Glasgow College of Social Sciences Research Ethics Committee (application number 400140186).

Results

Results will be disseminated through journal articles, national and international conferences. Findings will inform current and future welfare-to-work and job retention initiatives to extend healthy working lives.

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Information resources to aid parental decision-making on when to seek medical care for their acutely sick child: a narrative systematic review

Objective

To identify the effectiveness of information resources to help parents decide when to seek medical care for an acutely sick child under 5 years of age, including the identification of factors influencing effectiveness, by systematically reviewing the literature.

Methods

5 databases and 5 websites were systematically searched using a combination of terms on children, parents, education, acute childhood illness. A narrative approach, assessing quality via the Mixed Methods Appraisal Tool, was used due to non-comparable research designs.

Results

22 studies met the inclusion criteria: 9 randomised control trials, 8 non-randomised intervention studies, 2 qualitative descriptive studies, 2 qualitative studies and 1 mixed method study. Consultation frequency (15 studies), knowledge (9 studies), anxiety/reassurance (7 studies), confidence (4 studies) satisfaction (4 studies) and antibiotic prescription (4 studies) were used as measures of effectiveness. Quality of the studies was variable but themes supported information needing to be relevant and comprehensive to enable parents to manage an episode of minor illness Interventions addressing a range of symptoms along with assessment and management of childhood illness, appeared to have the greatest impact on the reported measures. The majority of interventions had limited impact on consultation frequencies, No conclusive evidence can be drawn from studies measuring other outcomes.

Conclusions

Findings confirm that information needs to be relevant and comprehensive to enable parents to manage an episode of minor illness. Incomplete information leaves parents still needing to seek help and irrelevant information appears to reduce parents' trust in the intervention. Interventions are more likely to be effective if they are also delivered in non-stressful environments such as the home and are coproduced with parents.

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Pathology and oncology in Africa: education and training for the future in cancer research– East African Regional Meeting

According to the World Health Organisation (WHO), deaths from non-communicable diseases (NCDs) will increase globally, with the largest increase being on the African continent. On our continent, projections have indicated that deaths from NCDs will exceed all combined communicable, maternal, perinatal and nutritional diseases as the most common causes of death by 2030. Hence, the importance of a functional and improved pathology system in the diagnosis of cancer cannot be debated.Recently, the African Organization for Research and Training in Cancer (AORTIC) organised its East African regional meeting in Mwanza, Tanzania on 25–26 June 2015, with the focus being 'Pathology and oncology: Education and training for the future in cancer research'. The main themes of the workshop were around improving cancer care and the role of twinning in Eastern Africa, in particular the Mwanza cancer project, telepathology, e-health and biobanking. The outcomes of a 2 day strategic meeting were developing an efficient and effective plan to guide the improvement in pathology training and cancer research in Africa.

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Prof Nigel Bundred gives an update on breast-conserving surgery at #SABCS15 https://t.co/ko3a7Ptxut @OfficialUoM

Prof Nigel Bundred gives an update on breast-conserving surgery at #SABCS15 https://t.co/ko3a7Ptxut @OfficialUoM

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MR imaging of ovarian masses: classification and differential diagnosis

Abstract

Objective

We propose a Magnetic Resonance Imaging (MRI) guided approach to differential diagnosis of ovarian tumours based on morphological appearance.

Background

Characterization of ovarian lesions is of great importance in order to plan adequate therapeutic procedures, and may influence patient's management. Optimal assessment of adnexal masses requires a multidisciplinary approach, based on physical examination, laboratory tests and imaging techniques. Primary ovarian tumours can be classified into three main categories according to tumour origin: epithelial, germ cell and sex cord-stromal tumours. Ovarian neoplasms may be benign, borderline or malignant. Using an imaging-guided approach based on morphological appearance, we classified adnexal masses into four main groups: unilocular cyst, multilocular cyst, cystic and solid, predominantly solid. We describe MR signal intensity features and enhancement behaviour of ovarian lesions using pathologically proven examples from our institution.

Conclusion

MRI is an essential problem-solving tool to determine the site of origin of a pelvic mass, to characterize an adnexal mass, and to detect local invasion. The main advantages of MRI are the high contrast resolution and lack of ionizing radiation exposure. Although different pathological conditions may show similar radiologic manifestations, radiologists should be aware of MRI features of ovarian lesions that may orientate differential diagnosis.

Teaching Points

• Diagnostic imaging plays a crucial role in detection, characterization and staging of adnexal masses.

• Characterization of an ovarian lesion may influence patient's management.

• Different pathological conditions may have similar radiologic manifestations.

• Non-neoplastic lesions should always be taken into consideration.

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Belen Rodriguez presenterà il nuovo programma Pequenos Gigantes con Stefano De Martino – LeiChic (Blog)

LeiChic (Blog)

Belen Rodriguez presenterà il nuovo programma Pequenos Gigantes con Stefano De Martino LeiChic (Blog) Belen Rodriguez è la showgirl argentina più discussa e criticata degli ultimi anni che nonostante questo è sempre riuscita ad andare avanti a testa alta senza mai farsi abbattere. Anche questa volta il pubblico ha cercato di abbatterla pensando che la … Incognita per 654 mila contratti a progettoMetro all 116 news articles »

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Comparison of tooth-borne and hybrid devices in surgically assisted rapid maxillary expansion: a randomized clinical cone-beam computed tomography study

The objective of this 2-arm, parallel, single-center trial was to compare the skeletal, dental, and periodontal effects of tooth-borne (TB) and hybrid devices in surgically assisted rapid maxillary expansion (SARME).

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A clinical study of the outcomes and complications associated with zygomatic buttress block bone graft for limited preimplant augmentation procedures

The aim of this study was to evaluate the possibility of using the zygomatic buttress as an intraoral bone harvesting donor site and determine the safety of this harvesting procedure for later optimal positioning of dental implants in accordance with prosthodontic and functional principles.

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A novel mutant 10Ala/Arg together with mutant 144Ser/Arg of Hepatitis B virus X protein involved in Hepatitis B Virus-related hepatocarcinogenesis in HepG2 cell lines

• Amino acid residues 10 and 144 of HBx anchored signature sequence in HCC tissues.• A10R-S144R mutation prolonged G1/S transition via regulation of cell cycle arrest.• A10R/S144R double-mutation decreased Bax expression and inhibited HepG2 apoptosis.

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Knockdown of Cathepsin L promotes radiosensitivity of glioma stem cells both in vivo and in vitro

• Expression of Cathepsin L and CD133 were correlated with human glioma malignancy.• Knockdown of Cathepsin L leads to radiosensitization in GSCs.• The improved radiosensitivity was through stemness, DNA repair, and apoptosis.• Knockdown of Cathepsin L exhibited less tumor growth after radiation in vivo.• Cathepsin L is a promising therapeutic target for clinical therapy in GBM patients.

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B-Cell Disorders and Curcumin

Clinical studies with patients with early hematological malignancies (ie, monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, or stage 0/1 chronic lymphocytic leukemia) suggest that early intervention with curcumin, derived from the spice turmeric, may lead to prolonged survival and delay in progressive disease in some of these patients.

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Subkutanes pannikulitisartiges T-Zell-Lymphom

Zusammenfassung

Bei 2 Patientinnen im Alter von 44 und 70 Jahren konnte nach klinisch-histopathologischer und molekularbiologischer Korrelation die Diagnose eines subkutanen pannikulitisartigen T-Zell-Lymphoms gestellt werden. Die klinische Morphologie des Lymphoms zeigte eine deutliche Variabilität. Bei einer Patientin fand sich ein singulärer erythematöser Knoten an der Kinnregion, bei der anderen fanden sich ausgedehnte plattenartige Resistenzen und Atrophien im Gesicht, an den Oberarmen und am vorderen Dekolleté. Ein assoziiertes Hämophagozytosesyndrom lag bei beiden Patientinnen nicht vor. Die Prognose des subkutanen pannikulitisartigen T-Zell-Lymphoms ohne assoziiertes Hämophagozytosesyndrom gilt als günstig. Durch eine Radiotherapie des singulären Befundes und durch eine systemische Prednisolon-Behandlung der ausgedehnten Manifestation konnte bei beiden Patientinnen eine komplette Remission erreicht werden.

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Salivary Biomarkers Associated With Bone Deterioration in Patients With Medication-Related Osteonecrosis of the Jaws

Kolokythas et al1 recently published an interesting article regarding the association of salivary biomarkers with bone deterioration. They suggested that using saliva, rather than serum or urine, could be an alternative for future studies of medication-related osteonecrosis of the jaw. Because it is the first report on the use of saliva for the detection of 2 bone turnover–related biomarkers (NTX and B-AP), a deeper look might be necessary:

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Volpara as a measurement tool for breast volume

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

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“Pelvic-Perineal Reconstruction with the Combined Transverse Upper Gracilis and Profunda Artery Perforator (TUG-PAP) Flap”

None of the authors received any funds or has any financial interests to disclose.

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Three historical papers for the septocutaneous perforator flaps of the thigh

Nowadays perforator flaps from the thigh area are frequently used. Despite of its common usage in reconstructions, there are scanty of papers which search for the origin of the perforator flaps of the thigh in historical perspective. This paper attempted to compare the three historical papers of the septocutaneous perforator flaps of the thigh.

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Assessment of sural flap microcirculation: Which position maintains the optimal perfusion?

Limb elevation is a common practice to reduce edema and to increase venous drainage. Considering the anatomy of the sural flap with retrograde perfusion and hence potentially difficult blood outflow, the best angle to positioning the leg following operation is not yet known.

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Complication rates in Sentinel Lymph Node Biopsy for Melanoma

Malignant melanoma is the 5th most common cancer in the UK, with 12, 818 new cases diagnosed in 2010 [1]. Surgery remains fundamental to treatment. Sentinel lymph node biopsy (SLNB) is indicated for those patients with a clinically negative nodal basin and a primary melanoma with a Breslow thickness of >1mm. The evidence for Completion Lymph Node Dissection (CLND) is under review with the final results of MSLT II available in 2022. Complication rates in the literature range between 5-10% [2-3]. The authors aimed to ascertain the risk of complications following SLNB in a regional unit.

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Results of combined vascular reconstruction by means of AV-Loops and free flap transfer in patients with soft tissue defects

Free flap transplantation to vascular reconstructions as arteriovenous loops and has been established in centers as a feasible therapeutic option for defect reconstruction in absence of proper recipient vessels, caused by oncologic resections, radiation or trauma. We report our 10-years experience in free flap transplantation after vascular reconstruction with special emphasis on complication rate and postoperative mobility.

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Treatment of hydrofluoric acid burns of the fingers

With great interest, we read the article published by Kim and colleagues, who reported their experience treating a 33-year-old man with thumb hydrofluoric acid burns using free flap reconstruction in the early stage.1 We appreciate the authors' superb microsurgery technique. However, we have some concerns regarding the treatment and management of this patient.

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Pedicled distal phalanx fillet flap for finger length preservation in trauma

Lawnmower injuries to the digits are becoming increasingly common and are often complex in nature with multiple levels of injury. The management of these injuries as with that of other hand injuries is often tailored to the individual patient considering factors such as occupation and hobbies with the ultimate goal of restoration of function and a sensate fingertip.The concept of using amputated, mangled or non-salvageable parts in a form of fillet flap has become more common in the recent years.

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Knockdown of Cathepsin L promotes radiosensitivity of glioma stem cells both in vivo and in vitro

• Expression of Cathepsin L and CD133 were correlated with human glioma malignancy.• Knockdown of Cathepsin L leads to radiosensitization in GSCs.• The improved radiosensitivity was through stemness, DNA repair, and apoptosis.• Knockdown of Cathepsin L exhibited less tumor growth after radiation in vivo.• Cathepsin L is a promising therapeutic target for clinical therapy in GBM patients.

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Knockdown of Cathepsin L promotes radiosensitivity of glioma stem cells both in vivo and in vitro

• Expression of Cathepsin L and CD133 were correlated with human glioma malignancy.• Knockdown of Cathepsin L leads to radiosensitization in GSCs.• The improved radiosensitivity was through stemness, DNA repair, and apoptosis.• Knockdown of Cathepsin L exhibited less tumor growth after radiation in vivo.• Cathepsin L is a promising therapeutic target for clinical therapy in GBM patients.

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A novel mutant 10Ala/Arg together with mutant 144Ser/Arg of Hepatitis B virus X protein involved in Hepatitis B Virus-related hepatocarcinogenesis in HepG2 cell lines

• Amino acid residues 10 and 144 of HBx anchored signature sequence in HCC tissues.• A10R-S144R mutation prolonged G1/S transition via regulation of cell cycle arrest.• A10R/S144R double-mutation decreased Bax expression and inhibited HepG2 apoptosis.

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B-Cell Disorders and Curcumin

Clinical studies with patients with early hematological malignancies (ie, monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, or stage 0/1 chronic lymphocytic leukemia) suggest that early intervention with curcumin, derived from the spice turmeric, may lead to prolonged survival and delay in progressive disease in some of these patients.

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Early breast cancer: Window of opportunity between diagnosis and treatment https://t.co/pICXoKU8De #SABCS15

Early breast cancer: Window of opportunity between diagnosis and treatment https://t.co/pICXoKU8De #SABCS15

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The Pharmacological Costs of TKIs in First-Line for Advanced NSCLC Patients with Activating EGFR-Mutations: A Review of Pivotal Phase III RCTs

Many driver mutations that determine the malignant behavior of lung cancer have been identified in recent years 1. The epidermal growth factor receptor (EGFR) signaling pathway is crucial for regulating tumorigenesis and cell survival and may be important in the development and progression of non-small cell lung cancer (NSCLC) 2. Activating mutation in exons 19 or 21 of EGFR in NSCLC are associated with increased sensitivity to EGFR-tyrosne kinase inhibitors (TKIs) 3. The 2nd ESMO Consensus Conference on Lung Cancer 3 has recommended that an EGFR TKI is the preferred first-line treatment in patients with EGFR-mutated NSCLC (strength of recommendation: A, level of evidence: I), as demonstrated by several randomised trials, with a superior response rate (RR) and progression free survival (PFS) as well as better Quality of Life (QoL) scores when compared with combination chemotherapy in the first-line setting.

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Sonic Hedgehog pathway activation is associated with resistance to platinum-based chemotherapy in advanced non-small cell lung carcinoma

Chemoresistance is a major challenge in the treatment of advanced non-small cell lung cancer (NSCLC). As the Sonic Hedgehog (Shh) pathway is reactivated in NSCLC, we investigated an association between chemoresistance and Shh activation.

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Results of a phase II trial of carboplatin, pemetrexed and bevacizumab for the Treatment of never or former/light smoking patients with stage IV NSCLC

We studied first line treatment of stage IV NSCLC with carboplatin, Pemetrexed and bevacizumab. We found a median PFS of 12.6 months, ORR of 47% and median OS of 20.3 months.

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First-line pemetrexed plus cisplatin followed by gefitinib maintenance therapy versus gefitinib monotherapy in East Asian never-smoker patients with locally advanced or metastatic nonsquamous non-small cell lung cancer: Quality of life results from a randomized phase 3 trial

In a randomized study of pemetrexed plus cisplatin followed by maintenance gefitinib (PC/G) or gefitinib monotherapy (G) in East Asian never-smoker patients with advanced nonsquamous non-small cell lung cancer, quality of life symptoms were more favorable in the G than PC/G group. In patients with wild-type epidermal growth factor receptor, tumor-related symptoms appeared to improve more with PC/G than G.

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A Randomized multicenter phase III study of single-administration of mecapegfilgrastim (HHPG-19K), a pegfilgrastim biosimilar, for prophylaxis of chemotherapy-induced neutropenia in patients with advanced non-small cell lung cancer (NSCLC)

The efficacy and safety profile of mecapegfilgrastim as prophylactic use among NSCLC patients in this two-stage study. From the double-blind stage and open label stage, not only the efficacy comparing mecapegfilgrastim and short action G-CSF was explored, but also the exact incidence of neutropenia and FN in this population was well studied.

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Immunohistochemical expression of K6, K8, K16, K17, K19, Maspin, Syndecan-1 (CD138), α-SMA and Ki-67 in amelob lastoma and ameloblastic carcinoma: diagnostic and prognostic correlations

To identify cut off values of markers that correlate with the histopathologic diagnosis of ameloblastic carcinoma (AC) and/or the increased recurrence potential of ameloblastoma (AB).

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CBCT constancy controls: How user-friendly is the new phantom?

In 2014 we presented a new phantom and software for simplified image quality assurance (IQA) controls of dental cone beam computed tomography units (CBCT)1. We received some comments concerning if the phantom and software are adapted to their purpose, which led us to conduct a pilot study to assess their user- friendliness for IQA constancy controls performed by clinical staff2. The EU guidelines on the use of CBCT3 states in its Basic Principles that "a quality assurance programme must be established and implemented for each CBCT facility, including equipment, techniques and quality control procedures".

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Objective validity of an implant-retained overdenture with a ball attachment system after marginal mandibulectomy

Implant-retained overdentures are known to improve oral function, but the clinical impact on patients who have had mandibular resections is still debatable. We have treated 16 patients who had such resections for oral cancer and consequent loss of the alveolar ridge, with overdentures supported by osseointegrated implants and ball attachments. To quantify their functional improvement, we evaluated their maximum bite force and masticatory performance. Their function improved significantly, (from 77.5N – 365N, 371% increase in maximum bite force, p<0.001) and masticatory performance increased (from 2.5 – 7.7, 208%, p<0.0001) after the overdentures had been inserted.

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Percutaneous sclerotherapy of arteriovenous malformations of the face using fibrin glue combined with OK-432 and bleomycin after embolisation

Congenital arteriovenous malformations (AVM) in the maxillofacial region are rare, but potentially life-threatening, vascular lesions. Here we review our experience of 13 patients with AVM of the facial soft tissues who were treated using percutaneous sclerotherapy with fibrin glue combined with OK-432 and bleomycin after embolisation. The mean (range) follow-up was 27 (14-58) months. Three of the lesions were completely controlled, eight were nearly completely controlled, and the other two were partly controlled.

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Influence of preservation of the alveolar ridge on delayed implants after extraction of teeth with different defects in the buccal bone

Our aim was to evaluate the influence of preservation of the alveolar ridge on delayed implants with different defects in the buccal bone. We enrolled 60 patients who had one posterior mandibular tooth extracted. Cone-beam computed tomography (CT) was used to measure the buccal bone defects in the alveolar ridge before the tooth was extracted (level A=3 to 5mm, and level B=more than 5mm). After the tooth had been extracted, the socket either had the alveolar ridge preserved (trial group) or it was left to heal spontaneously (control group).

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Award-Winning Study of High-Risk Head & Neck Patients Documents Key Role for … – LWW Journals

Award-Winning Study of High-Risk Head & Neck Patients Documents Key Role for … LWW Journals SAN ANTONIO—For head and neck cancer patients at high-risk for adverse events after chemoradiotherapy, more frequent follow-up appointments in an outpatient clinic led by advanced practice nurses (APNs) resulted in fewer post-treatment emergency …

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Pedicled distal phalanx fillet flap for finger length preservation in trauma

Lawnmower injuries to the digits are becoming increasingly common and are often complex in nature with multiple levels of injury. The management of these injuries as with that of other hand injuries is often tailored to the individual patient considering factors such as occupation and hobbies with the ultimate goal of restoration of function and a sensate fingertip.The concept of using amputated, mangled or non-salvageable parts in a form of fillet flap has become more common in the recent years.

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“Pelvic-Perineal Reconstruction with the Combined Transverse Upper Gracilis and Profunda Artery Perforator (TUG-PAP) Flap”

None of the authors received any funds or has any financial interests to disclose.

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Treatment of hydrofluoric acid burns of the fingers

With great interest, we read the article published by Kim and colleagues, who reported their experience treating a 33-year-old man with thumb hydrofluoric acid burns using free flap reconstruction in the early stage.1 We appreciate the authors' superb microsurgery technique. However, we have some concerns regarding the treatment and management of this patient.

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Impact of the number of veins repaired in short-term digital replantation survival rate

Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus multiple veins.

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Assessment of sural flap microcirculation: Which position maintains the optimal perfusion?

Limb elevation is a common practice to reduce edema and to increase venous drainage. Considering the anatomy of the sural flap with retrograde perfusion and hence potentially difficult blood outflow, the best angle to positioning the leg following operation is not yet known.

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