Publication date: Available online 24 April 2017
Source:American Journal of Infection Control
Author(s): Chibueze A. Nwaiwu, Francesco M. Egro, Saundra Smith, Jay D. Harper, Alexander M. Spiess
BackgroundThe studies enumerating the risk of HIV transmission to health care workers (HCWs) as 0.3% after percutaneous exposure to HIV-positive blood, and 0.09% after a mucous membrane exposure, are weakened by dated literature. Our study aims to demonstrate the seroconversion rate after exposure to HIV-contaminated body fluids in a major academic center in the United States.MethodsA prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at an academic medical center was analyzed. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, involvement of resident physicians, use of postexposure prophylaxis, and patients' HIV, hepatitis B virus, and hepatitis C virus status.ResultsA total of 266 cases were included in the study. Most exposures were caused by percutaneous injuries (52.6%), followed by 43.2% mucocutaneous injuries. Of the injuries, 52.6% were to the hand and 33.5% to the face and neck. Blood exposure accounted for 64.3% of all cases. Of the patients, 21.1% received postexposure prophylaxis. None of the HCWs exposed to HIV-contaminated body fluids seroconverted (seroconversion rate, 0%).ConclusionsHIV does not seem to be as easily transmitted by needlestick, laceration, or splash injuries as previously surmised. Further large-scale and multicenter studies are needed for a more accurate estimation of the risk of transmission of HIV in U.S. health care workers.
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Δευτέρα 24 Απριλίου 2017
Seroconversion rate among health care workers exposed to HIV-contaminated body fluids: The University of Pittsburgh 13-year experience
Psychosocial determinants of influenza vaccination intention: A cross-sectional study on inpatient nurses in Singapore
Source:American Journal of Infection Control
Author(s): Dwee Wee Lim, Lay Tin Lee, Win Mar Kyaw, Angela Chow
Nurses have the closest interaction with inpatients and could transmit influenza to patients. From a self-administered questionnaire survey among inpatient nurses at a tertiary hospital, we observed that the strongest factors associated with intention for future vaccination were perceived benefits of and motivations for vaccination (adjusted odds ratio [aOR], 3.30; 95% confidence interval [CI], 2.55-4.27), and perceived nonsusceptibility to influenza and preference for vaccination alternatives (aOR, 0.26; 95% CI, 0.20-0.34). These factors need to be addressed to increase vaccination uptake and prevent nosocomial transmission.
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Health care providers' perspectives for providing quality infection control measures at the neonatal intensive care unit, Cairo University Hospital
Source:American Journal of Infection Control
Author(s): Marwa Rashad Salem, Meray Rene L. Youssef
BackgroundHealth care–associated infections are one of the major causes of morbidity and mortality in neonatal intensive care units (NICUs). This study identified health care providers' perspectives for providing quality infection control measures at a NICU.MethodsA qualitative approach was adopted. Participants were selected via a purposive sampling technique. The study group was composed of 3 medical staff who held leadership positions and 10 nurses working in the NICU at Cairo University Hospital. Data were collected using semi-structured interviews.ResultsResponses were analyzed using a thematic content analysis. The priorities identified by thematic analysis were suggestions and barriers for providing quality infection control measures, from the perspectives of health care providers. All interviewees cited shortage in staffing, especially nurses, lack of time to apply infection control standards, limited opportunities for infection control training, and work overload as the main barriers. All interviewees recommended on-going training and the introduction of audiovisual aids and case study approaches.ConclusionsLack of time to apply infection control standards, limited opportunities for infection control training, and work overload are the most commonly perceived barriers. The current infection control system in the NICU is likely to remain ineffective unless these underlying barriers are adequately addressed.
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Validation of quality assurance criteria for rectal surveillance cultures
Source:American Journal of Infection Control
Author(s): Ma'ayan Amar, Amos Adler
We aimed to validate quality assurance (QA) criteria for rectal surveillance cultures (RSCs) for extended-spectrum β-lactamase-producing Enterobacteriaceae. QA for RSCs were tested by observing the presence or absence of fecal soiling and by examining the growth of Enterobacteriaceae on MacConkey agar. Extended-spectrum β-lactamase-producing Enterobacteriaceae were detected in 136 out of 434 soiled swabs (31.3%) and in 61 out of 257 nonsoiled swabs (23.7%) (P = .036). Observation of fecal soiling on RSCs can serve as a simple QA criterion and prevent the reporting of false-negative results.
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Better knowledge and regular vaccination practices correlate well with higher seasonal influenza vaccine uptake in people at risk: Promising survey results from a university outpatient clinic
Source:American Journal of Infection Control
Author(s): Işıl Adadan Güvenç, Hülya Parıldar, Mustafa Kürşat Şahin, Selim Sermed Erbek
BackgroundThe knowledge, beliefs, opinions, and attitudes of patients and their relatives regarding seasonal influenza vaccination were evaluated.MethodsThis descriptive study was undertaken in the outpatient clinics of Baskent University Hospital. There were 566 responders who completed a self-administered questionnaire.ResultsThe mean age of participants was 48.35 years, and 16.8% were ≥65 years. Of the responders, 21.7% were vaccinated this year, whereas 57.8% did not desire to get it. Vaccination rates were significantly higher among responders ≥65 years of age (56.4%), those having at least 1 chronic illness (46.5%), and those who were vaccinated regularly every year (22.2%). Half of the responders did not know that the vaccine was reimbursed for people at risk. The most common reason for refusing the influenza vaccine was not getting the flu frequently (51.2%). Fear of side effects, concerns about vaccine's effectiveness, and belief that vaccine causes the flu were other common reasons for not being vaccinated. Of the responders, 77% believed that getting official information or a recommendation from a physician would influence their decision about seasonal influenza vaccination.ConclusionsPeople who are at risk or vaccinated regularly display a higher vaccine uptake and better knowledge of influenza and vaccination. The opinions and attitudes of this study population may assist in developing strategies for changing attitudes of the public toward influenza vaccination.
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Seroconversion rates among health care workers exposed to hepatitis C virus–contaminated body fluids: The University of Pittsburgh 13-year experience
Source:American Journal of Infection Control
Author(s): Francesco M. Egro, Chibueze A. Nwaiwu, Saundra Smith, Jay D. Harper, Alexander M. Spiess
BackgroundHepatitis C virus (HCV) transmission to health care personnel (HCP) after exposure to a HCV-positive source has been reported to occur at an average rate of 1.8% (range, 0%-10%). We aimed to determine the seroconversion rate after exposure to HCV-contaminated body fluid in a major U.S. academic medical center.MethodsA longitudinal analysis of a prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at the University of Pittsburgh Medical Center was performed. Data collected include type of injury and fluid, injured body part, contamination of sharps, resident physicians' involvement, and patients' hepatitis B virus (HBV), HCV, and HIV status.ResultsA total of 1,361 cases were included in the study. Most exposures were caused by percutaneous injuries (65.0%), followed by mucocutaneous injuries (33.7%). Most (63.3%) were injuries to the hand, followed by the face and neck (27.6%). Blood exposure accounted for 72.7%, and blood-containing saliva accounted for 3.4%. A total of 6.9% and 3.7% of source patients were coinfected with HIV and HBV, respectively. The HCV seroconversion rate was 0.1% (n = 2) because of blood exposure secondary to percutaneous injuries.ConclusionsThis study provides the largest and most recent cohort from a major U.S. academic medical center. The seroconversion rates among HCP exposed to HCV-contaminated body fluids was found to be lower than most of the data found in the literature.
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Dynamics of B cell recovery following kidney/bone marrow transplant recipients.
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Biologic treatments for elderly patients with psoriasis
Abstract
The number of elderly patients with psoriasis is increasing in Japan. However, biologic treatment is generally considered to be challenging in elderly patients, due to their increased risk of complications compared with younger patients. Our retrospective study aimed to evaluate the safety profile and efficacy of biologics in senior elderly patients (≥75 years old) with psoriasis. The study involved a cohort of 27 patients aged 75–88 years who were being treated with biologics over a period of more than 1 year. Initial biologics administrated to were adalimumab (five cases) and ustekinumab (22 cases). Eight patients discontinued treatment: two developed cancer; one was transferred to hospital; and five others experienced either bone fracture, interstitial pneumonia, cerebral hemorrhage resulting in death, decrepitude or developed hepatopathy following prophylactic tuberculosis treatment. Efficacy, evaluated by the percentage of patients achieving 75% reduction of Psoriasis Area and Severity Index score, was 76.9% at week 16 (n = 26), 88.0% at week 24 (n = 25) and 90.5% at week 52 (n = 21). Biologic treatments thus show clear efficacy in elderly patients with psoriasis, however, the increased frequency of adverse events requires rigorous patient observation.
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Effect of photoactivation on the reduction of composite resin contamination
Composite resins are predominantly marketed in developing countries in tube form, and the contents of the tube may be used in numerous procedures for different patients. This represents a problem because of the risk of cross-contamination. This study aimed to evaluate contamination in vitro of the internal contents of composite resin tubes in the dental clinics of a higher-education institution, as well as the effect of photoactivation on the level of contamination. Twenty-five tubes containing composite resin were randomly chosen (by lottery). From each tube, two samples of approximately 2 mm of composite resin were removed, and then one sample, but not the other, was photoactivated. These samples were plated on Brain–Heart Infusion (BHI), Sabouraud and MacConkey agars, and the plates were incubated at 37°C for 24–48 h. Colony counting and Gram staining were performed for subsequent microscopic identification of fungi and bacteria. The non-photoactivated composite resin group presented significantly higher microbial contamination in relation to the photoactivated composite resin group. The photoactivation of camphorquinone present in composite resin produces reactive oxygen species, which might promote cell death of contaminant microorganisms. Thus, although the same tube of composite resin may be used for a number of different patients in the dental clinics of developing countries, the photoactivation process potentially reduces the risk of cross-contamination.
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Prediabetes Exhibits Decreased Disposition Index Correlated with Deterioration of Glycemic Parameters in Nonobese Japanese Subjects: A Cross-Sectional Study from Medical Examination
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
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A pseudotumour of the thigh: tensor fasciae latae muscle hypertrophy due to an underlying abductor tendon tear
We present a patient with an asymptomatic unilateral swelling of the anterolateral thigh. MRI showed hypertrophy of the tensor fasciae latae muscle due to an underlying gluteus minimus tendon tear.
Abductor tendon tears can present with swelling of the thigh due to secondary tensor fasciae latae muscle hypertrophy.
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Rapid emergence of FKS mutations in Candida glabrata isolates in a peritoneal candidiasis
Publication date: Available online 25 April 2017
Source:Medical Mycology Case Reports
Author(s): Milène Sasso, Claire Roger, Laurence Lachaud
We report a rapid acquisition of echinocandin resistance after 12 days of micafungin treatment, without prior exposure, in a patient with peritoneal candidiasis due to C. glabrata. Isolates recovered before and after treatment were compared by multilocus sequence typing. Results of antifungal susceptibility testing and FKS mutations were reported. The interest of repeating antifungal susceptibility testing for echinocandin molecules during the treatment is discussed and a strategy to research FKS mutations proposed.
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Successful long-term terbinafine therapy in an asthmatic patient with Aspergillus sensitization and bronchiectasis
Publication date: Available online 25 April 2017
Source:Medical Mycology Case Reports
Author(s): Isabel Rodriguez-Goncer, Rob Niven, David W Denning
Severe asthma with fungal sensitization (SAFS) is estimated to affect ~25% of patients with poorly controlled asthma. Tri-azole therapy is effective in only 60–80% and side effects are common. We report a 25 years-old woman with severe asthma, Aspergillus sensitization and marked bronchiectasis that developed a rare Achilles-tendinopathy with both itraconazole and voriconazole. She started a trial with terbinafine as salvage therapy that led to a striking improvement and long-term control of her respiratory disease.
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Fullerene: biomedical engineers get to revisit an old friend
Publication date: Available online 24 April 2017
Source:Materials Today
Author(s): Saba Goodarzi, Tatiana Da Ros, João Conde, Farshid Sefat, Masoud Mozafari
In 1985, the serendipitous discovery of fullerene triggered the research of carbon structures into the world of symmetric nanomaterials. Consequently, Robert F. Curl, Harold W. Kroto and Richard E. Smalley were awarded the Noble prize in chemistry for their discovery of the buckminsterfullerene (C60 with a cage-like fused-ring structure). Fullerene, as the first symmetric nanostructure in carbon nanomaterials family, opened up new perspectives in nanomaterials field leading to discovery and research on other symmetric carbon nanomaterials like carbon nanotubes and two-dimensional graphene which put fullerenes in the shade, while fullerene as the most symmetrical molecule in the world with incredible properties deserves more attention in nanomaterials studies. Buckyball with its unique structure consisting of sp2 carbons which form a high symmetric cage with different sizes (C60, C70 and so on); however, the most abundant among them is C60 which possesses 60 carbon atoms. The combination of unique properties of this molecule extends its applications in divergent areas of science, especially those related to biomedical engineering. This review aims to be a comprehensive review with a broad interest to the biomedical engineering community, being a substantial overview of the most recent advances on fullerenes in biomedical applications that have not been exhaustively and critically reviewed in the past few years.
Graphical abstract
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Tapping into liquid precursors of crystals
Source:Materials Today
Author(s): Ashit Rao
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Penetration Time Profiles for Two Class 3B Lasers in In Situ Human Achilles at Rest and Stretched
Photomedicine and Laser Surgery , Vol. 0, No. 0.
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Major Immunodominant Region of Hepatitis B Virus Core Antigen as a Delivery Vector to Improve the Immunogenicity of the Fusion Antigen ROP2-SAG1 Multiepitope from Toxoplasma gondii in Mice
Viral Immunology , Vol. 0, No. 0.
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Modes of Action for Mucosal Vaccine Adjuvants
Viral Immunology , Vol. 0, No. 0.
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Exostosin 1 is expressed in human odontoblasts
Source:Archives of Oral Biology, Volume 80
Author(s): Virve Pääkkönen, Stina Saraniemi, Françoise Bleicher, Zvi Nevo, Leo Tjäderhane
ObjectiveDental pulp is soft connective tissue maintaining the vitality of the tooth, while odontoblasts form the dentin. Our earlier DNA microarray analysis revealed expression of putative tumour suppressor exostosin 1 (EXT-1) in odontoblasts. EXT-1 is essential for heparan sulphate synthesis, which may play a role in the dentin mineralization. Since the absence of the functional EXT-1 causes bone tumours, expression in odontoblasts is interesting. Our aim was to analyse further the EXT-1 expression in human tooth.DesignsDNA microarray and PCR techniques were used to study the EXT-1 expression in mature native human odontoblasts and pulp tissue as well as in newly-differentiated cultured odontoblast-like cells. Immunohistochemistry was performed to study EXT-1 protein in mature human teeth, teeth with incomplete root and developing teeth.ResultsMarkedly higher EXT-1 was observed in mature odontoblasts than in pulp at mRNA level with DNA microarray and PCR techniques. Immunohistochemistry of mature tooth revealed EXT-1 both in odontoblasts and the predentin but not in the dentin. EXT-1 was also observed in the odontoblasts of incomplete root, but the localization of the staining was different. In developing foetal tooth, staining was detected in ameloblasts and the basal lamina.ConclusionsThe detection of EXT-1 in both mature and newly-differentiated cells indicates a role in the odontoblast function, and EXT-1 staining in the predentin indicates a function in the dentin formation. Detection of EXT-1 in developing teeth indicates a role in tooth development.
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Alternative sweeteners influence the biomass of oral biofilm
Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Fathilah Abdul Razak, Baizatul Amirah Baharuddin, Elisya Farha Mohd. Akbar, Amira Hanim Norizan, Nur Fazilah Ibrahim, Md. Yusoff Musa
ObjectiveCompact-structured oral biofilm accumulates acids that upon prolonged exposure to tooth surface, causes demineralisation of enamel. This study aimed to assess the effect of alternative sweeteners Equal Stevia®, Tropicana Slim®, Pal Sweet® and xylitol on the matrix-forming activity of plaque biofilm at both the early and established stages of formation.MethodsSaliva-coated glass beads (sGB) were used as substratum for the adhesion of a mixed-bacterial suspension of Streptococcus mutans, Streptococcus sanguinis and Streptococcus mitis. Biofilms formed on sGB at 3h and 24h represented the early and established-plaque models. The biofilms were exposed to three doses of the sweeteners (10%), introduced at three intervals to simulate the exposure of dental plaque to sugar during three consecutive food intakes. The treated sGB were (i) examined under the SEM and (ii) collected for turbidity reading. The absorbance indicated the amount of plaque mass produced. Analysis was performed comparative to sucrose as control.ResultsHigher rate of bacterial adherence was determined during the early compared to established phases of formation. Comparative to the sweeteners, sucrose showed a 40% increase in bacterial adherence and produced 70% more plaque-mass. Bacterial counts and SEM micrographs exhibited absence of matrix in all the sweetener-treated biofilms at the early phase of formation. At the established phase, presence of matrix was detected but at significantly lower degree compared to sucrose (p<0.05).ConclusionAlternatives sweeteners promoted the formation of oral biofilm with lighter mass and lower bacterial adherence. Hence, suggesting alternative sweeteners as potential antiplaque agents.
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Heterogeneous Prognoses for pT3 Papillary Thyroid Carcinomas and Impact of Delayed Risk Stratification
Thyroid , Vol. 0, No. 0.
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Heterogeneous Prognoses for pT3 Papillary Thyroid Carcinomas and Impact of Delayed Risk Stratification
Thyroid , Vol. 0, No. 0.
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Autophagy: A brief overview in perspective of dermatology
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):290-297
Autophagy, literally meaning "self-eating," is an intracellular catabolic process of delivering cytosol and/or its specific content to the lysosomes for degradation.The resulting macromolecular constituents are recycled and utilized again by the cells. Basal level autophagy plays an important role in cellular homeostasis through the elimination of the old or damaged organelles, as well as aggregated intracellular proteins. Autophagy refers to sequestration of intact organelles along with a portion of cytosol, into a double-or multi-membrane structure known as phagophore, which elongates, and after closure, forms a vesicular structure known as the autophagosome. Subsequently, the mature autophagosome fuses with a lysosome, thereby forming a single membrane structure, an autolysosome. Autophagy plays a critical role in inflammation, autoimmunity and cellular differentiation. Skin serves as the first line of defense against a variety of environmental insults and autophagy is thought to be a form of an endogenous defense mechanism against such environmental derangements. Autophagy has been linked with keratinocyte differentiation and melanocyte survival, as well as with the pathogenesis of diverse skin disorders including systemic lupus erythematosus, systemic sclerosis, psoriasis, vitiligo, infectious skin diseases and cancer. Autophagy has been one of the most studied phenomena in cell biology and pathophysiology, and given its broad clinical implications, has become a major target for drug discovery. The last decade has seen a substantial upsurge in autophagy-related research and publications; still, the dermatology literature appears to be less initiated. Autophagy will probably change our understanding of dermatological disorders/medicines. Hence, a basic knowledge of autophagy is a prerequisite to understand the developments in the field of autophagy-related research.
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Seborrheic melanosis: An entity worthy of mention in dermatological literature
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):285-289
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Scrotal lymphangiectasia following scrofuloderma
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):397-398
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Leaving a mark: Multiple geometric areas of alopecia
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):373-375
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Erratum: Digital volumetric measurement of cutaneous leishmaniasis lesions: Blur estimation method
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):414-414
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Update on etiopathogenesis and treatment of Acne
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):298-306
Acne, the most common skin disease, is a disorder of pilosebaceous units that affects adolescents mainly and adults occasionally. The pathogenesis is multifactorial. Besides genetic predisposition, other major factors include the action of androgens, pro-inflammatory lipids acting as ligands of peroxisome proliferator-activated receptors in the sebocytes, toll-like receptor-2 acting on keratinocytes, recognition of pathogen-associated molecular patterns, cytokines, chemokines, inflammasomes, neuroendocrine regulatory mechanisms, diet and other pro-inflammatory targets implicated in the activation of immune detection and response. Most of these factors converge on mammalian target of rapamycin complex1 (mTORC1) activation which is further enhanced by the nutrient signaling of Western diet. This multitude of pathogenic factors has led to a new armamentarium of drugs for the treatment of acne. Topical anti-androgens, insulin-like growth factor-1 inhibitors, peroxisome proliferator-activated receptor-modulators, acetylcholine inhibitors, topical retinoic acid metabolism-blocking agents, vitamin D analogues, antimicrobial peptides, interleukin-1α and interleukin-1β blockers and immunotherapy are some of the novel treatment options.
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Dermatoscopic evaluation of three cases of nevus lipomatosus cutaneous superficialis
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):383-386
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Digital volumetric measurement of cutaneous leishmaniasis lesions: Blur estimation method
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):307-311
Background: Cutaneous leishmaniasis is a common parasitic infestation in Iran. With recent advantages in digital imaging, we have devised a novel non-contact objective method of measuring lesions. Aim: The aim of the study was to design a software system that analyzes images of cutaneous leishmaniasis lesions, objectively assess and monitor volume. Methods: A photographic technique along with an image processing algorithm was applied to extract a three-dimensional map of the lesion from a simple two-dimensional picture. This method recovers depth on the basis of blur estimation. A macro lens with a low depth of field was used to blur the objects out of focus. To assess and compare the results, a polymer mold of the corresponding lesion was made and filled with liquid. The volume of liquid corresponded to the volume of the lesion. A total of thirty-seven patients were enrolled, and 48 lesions were analyzed. Results: The mean volume measured by image processing was 159 μl (range: 8–685 μl), in comparison to an average of 170 μl (range: 6–800 μl) obtained from the molds. This was not significantly different. Statistical analysis by the Pearson correlation test showed a 'very good fit' correlation between these measured volumes (P < 0.001, r = 0.938). Limitation: The location and height of lesions were two important limitations in implementing this technique. If the lesion location is in the curvature region of body or the lesion height is less than 1 mm or more than 1 cm, this method will lose precision and accuracy. Conclusion: Image processing with blur estimation technique is an accurate and precise method to measure the volume of lesions in cutaneous leishmaniasis.
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Giant, mutilating facial lupus vulgaris due to long-term misdiagnosis
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):412-412
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Effectiveness, safety and tolerability of cyclosporine versus supportive treatment in Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A record-based study
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):312-316
Background: Toxic epidermal necrolysis and Stevens–Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens–Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy. Aims: This study is an observational, record-based study comparing the effectiveness and safety of patients receiving cyclosporine versus only supportive therapy. Methodology: Medical records as bed-head tickets and laboratory investigation reports of Stevens–Johnson syndrome/toxic epidermal necrolysis patients admitted in the hospital over a period of 1 year were collected. Data regarding clinico-demographic profile, suspected drug causing Stevens–Johnson's syndrome/toxic epidermal necrolysis, SCORTEN, body surface area involved, treatment received and outcome were obtained. Results: Twenty-eight patients were analyzed. Nineteen belonged to the cyclosporine group (supportive treatment + cyclosporine), nine to supportive treatment only group. Among the suspected drugs, antiepileptics formed the major group (28.6%). Five patients in the supportive only group and one in the cyclosporine group died. Time for stabilization and reepithelialization and duration of recovery were significantly lower in the cyclosporine group (P < 0.001, P= 0.007, P= 0.01, respectively). The standardized mortality ratio was 0.32 in cyclosporine group which is nearly 3.3 times lower than the only supportive treatment. Limitations: As it was a record-based study, certain confounding factors (serum blood urea nitrogen) could not be adjusted. Conclusion: Cyclosporine (5 mg/kg/day) for 10 days from onset of Stevens–Johnson syndrome/toxic epidermal necrolysis may decrease the risk of dying, may provide faster healing of lesions and might lead to early discharge from hospital.
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Unilateral monomorphic hypopigmented macules: A variant of Darier disease
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):369-371
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Low-dose rituximab as an adjuvant therapy in pemphigus
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):317-325
Background: Pemphigus is a chronic autoimmune blistering disease where systemic steroids and immunosuppressants are the mainstay of therapy, but long-term treatment with these agents is associated with many side effects. Rituximab, a chimeric monoclonal anti-CD20 antibody, in low doses has shown efficacy as an adjuvant to reduce the dose of steroids. Aim: To study the clinical efficacy and safety of low-dose rituximab as an adjuvant therapy in pemphigus. Methods: Fifty patients with extensive pemphigus were selected, who either had recalcitrant pemphigus, were steroid dependent, had relapsed after pulse therapy, had anti-desmoglein levels >20, had contraindications to conventional treatment or wanted to avoid conventional treatment and its side effects. Two doses of rituximab (500 mg) were given 2 weeks apart and patients were regularly followed up every 2 weeks for 3 months and then monthly upto 2 years. Complete blood counts, liver function tests, renal function tests, skin biopsy, direct immunofluorescence and desmoglein levels were checked before and after rituximab administration. Pre-rituximab chest X-ray and electrocardiograph were also obtained. Results: At 3 months, 41 (82%) patients showed complete remission. Nine (18%) patients had partial remission. After 6–12 months, 20 (40% of enrolled patients) continued to be in remission and were off all systemic therapy and the remaining 19 (38%) were continuing to take low doses of steroids with or without other adjuvant immunosuppressants and 2 (4%) had to be given another 2 doses of rituximab and subsequently could be managed with low-dose steroids. Of the 9 patients in partial remission at 3 months, after 6–12 months 5 (10% of the total) were completely off treatment and went into complete remission and 4 (8%) were on additional treatment out of which 2 (4%) had to be given 2 additional doses of rituximab and were in partial remission with low-dose therapy at the end of 12 months. One patient developed urticaria as a side effect. Another developed herpes zoster. Conclusion: Our results show that low-dose rituximab is a well-tolerated and beneficial adjuvant therapy in recalcitrant pemphigus which helps reduce both the severity of disease as well as the dose of steroids and immunosuppressants.
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Clear cell papulosis: A case report and its possible association with epidermal immature dendritic cells
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):379-381
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Clinico-epidemiological study of tinea incognito with microbiological correlation
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):326-331
Background: Tinea incognito is a dermatophytic infection with a clinical presentation that is modified due to previous treatment with topical or systemic steroids, as well as topical immunomodulators. It tends to mimic other dermatological conditions. Aims: To evaluate the various clinical manifestations, sites, predisposing factors and causative agents of tinea incognito. Methods: A prospective observational study was done on one hundred clinically suspected cases of tinea incognito, with a history of topical or systemic steroid use for a period of at least six weeks. They were subject to direct microscopy and fungal culture, and re-evaluated at the end of the third and sixth week. Results: Eczema-like conditions were the most common clinical manifestation, followed by inflammatory, autoimmune and infective conditions. The face was the most commonly affected site. Direct microscopy was positive in 85% of cases, and fungal culture was positive in 63% of cases. Trichophyton rubrum was the most common species isolated. Pharmacists were responsible for 78% of tinea incognito cases, and betamethasone dipropionate was the most common drug used. Limitations: As this was a hospital outpatient-based study, cases with severe systemic problems could have attended other departments. Cases involving the hair and nails were negligible. Conclusions: Tinea incognito is a commonly encountered, yet poorly reported entity in the study population. An increased level of awareness and vigilance on the sale of steroid containing compounds will help control this dermatological condition.
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A combination of oral azathioprine and methotrexate in difficult to treat dermatoses
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):389-392
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Successful treatment of Rosai–Dorfman disease using in situ photoimmunotherapy
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):332-336
Rosai–Dorfman disease is difficult to cure. In situ photoimmunotherapy combines local photothermal therapy with immunoadjuvant. In the present case report, a 39-year-old Chinese man with Rosai–Dorfman disease lesions below the left nostril and left preauricular region was treated with in situ photoimmunotherapy. The patient was treated with daily application of topical imiquimod (5%) and laser irradiations every 2 weeks for 8 weeks. After three cycles of treatment, the lesions improved markedly without adverse effects. Our results showed that in situ photoimmunotherapy can be used as an effective treatment for Rosai–Dorfman disease.
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Unusual targetoid nodule on the back
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):408-410
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Clinical characteristics of acquired ungual fibrokeratoma
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):337-343
Background: Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors located in the ungual area. Though there are many reports of this entity, only some reports have reviewed the clinical features of the tumor. Aims: The aim of this study was to clarify the clinical characteristics of acquired ungual fibrokeratomas. Methods: We reviewed twenty patients who were treated surgically at our clinic from 2003 to 2014 for acquired ungual fibrokeratomas confirmed on histopathological examination. Our study was conducted by retrospective analysis of charts, clinical pictures and patient records. Cases of tuberous sclerosis were not included. Results: Acquired ungual fibrokeratomas occurred on toenails in 16 (80%) patients and on fingernails in 4 (20%) patients. Periungual lesions were noted in 15 (75%) patients followed by intraungual lesions in 4 (20%) patients and subungual lesions in 1 (5%) patient. A longitudinal groove was observed in 80% of patients. Surgical resection was performed in all cases for both medical and cosmetic reasons. After excision, recurrence occurred in three cases. Limitations: This was a retrospective study of a limited number of patients. Conclusions: Acquired ungual fibrokeratomas occurred more commonly on toenails than on fingernails and were located in the periungual area in most patients. A longitudinal groove in the nail plate was a frequent finding. Surgical resection led to medical and cosmetic improvement with a recurrence in 3 (15%) patients.
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Postsurgical pyoderma gangrenosum successfully treated with cyclosporine
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):412-412
http://ift.tt/2pfEQCi
Tinea pseudoimbricata
Indian Journal of Dermatology, Venereology, and Leprology 2017 83(3):344-345
http://ift.tt/2pcaMW6
Changes in Perception-Action Tuning Over Long Time Scales: How Children and Adults Perceive and Act on Dynamic Affordances When Crossing Roads.
http://ift.tt/2pfOULv
Contingent Capture Is Weakened in Search for Multiple Features From Different Dimensions.
http://ift.tt/2pZ1nB7
Distractor Probability Changes the Shape of the Attentional Template.
http://ift.tt/2opOFyo
Safety of endoscopic sinus surgery in children with cystic fibrosis
Data on the safety of endoscopic sinus surgery (ESS) are limited in children with cystic fibrosis (CF). We used a multi-institutional surgical registry to examine ESS outcomes in children with CF.
http://ift.tt/2q8RXm0
Otorhinolaryngologic Manifestations of Hartsfield Syndrome: Case Series and Review of Literature
Diagnosis of Hartsfield syndrome includes recognition of three distinct clinical anomalies: holoprosencephaly, ectrodactyly, and bilateral cleft-lip and palate syndrome. A family including three male siblings all affected by Hartsfield syndrome presented to our institution for care. An autosomal dominant variant in Fibroblast Growth Factor Receptor 1 (FGFR1) was identified. This report focuses on otorhinolaryngologic manifestationsof Hartsfield syndrome, previously undescribed, including midline defects of holoprosencephaly, bilateral cleft-lip and palate, retrognathia, gastroesophageal reflux disease, external ear anomalies, eustachian tube dysfunction, and midface abnormalities, in addition to multidisciplinary, long-term management strategies.
http://ift.tt/2pugmWH
The effect of perioperative dexamethasone dosing on post-tonsillectomy hemorrhage risk
Dexamethasone is currently recommended for routine prophylaxis against postoperative nausea and vomiting after tonsillectomy procedures. However, some studies have raised concern that dexamethasone use may lead to higher rates of post-tonsillectomy hemorrhage. Our objective was to determine whether higher doses of dexamethasone administered perioperatively during tonsillectomy procedures are associated with an increased risk of secondary post-tonsillectomy hemorrhage.
http://ift.tt/2q8yHF8
The effect of blocking Notch signaling by γ-secretase inhibitor on allergic rhinitis
This study aimed to investigate the effect of blocking Notch signaling by γ-secretase inhibitor (GSI) on allergic rhinitis.
http://ift.tt/2pu7FMa
Not So Fast: Complete Revascularization of the ST-Segment-Elevation Myocardial Infarction Patient Is Not Yet Proven.
http://ift.tt/2oFg6zu
Hypertension Treatment and Outcomes in the Era of Population Health, Coordinated Care, and Medicare Access and CHIP Reauthorization Act (MACRA).
http://ift.tt/2oFcmht
Complete Immediate Revascularization of the Patient With ST-Segment-Elevation Myocardial Infarction Is the New Standard of Care.
http://ift.tt/2oZEoHH
Weight Loss and Heart Failure: A Nationwide Study of Gastric Bypass Surgery Versus Intensive Lifestyle Treatment.
http://ift.tt/2oZw5vx
Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction.
http://ift.tt/2oF1Uqg
Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I.
http://ift.tt/2oZnVmQ
Clinician's Guide to Early Rule-Out Strategies With High-Sensitivity Cardiac Troponin.
http://ift.tt/2oFgu0S
Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections From NHANES (National Health and Nutrition Examination Survey).
http://ift.tt/2oZn3Pe
Sheet-Like Remodeling of the Transverse Tubular System in Human Heart Failure Impairs Excitation-Contraction Coupling and Functional Recovery by Mechanical Unloading.
http://ift.tt/2oZwBJZ
Subcellular Remodeling of the T-Tubule Membrane System: The Limits of Myocardial Recovery Revealed?.
http://ift.tt/2oF03BS
Letter by Koh Regarding Article, "Pleiotropic Effects of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitors?".
http://ift.tt/2oF3zMm
Emerging Affinity-Based Proteomic Technologies for Large-Scale Plasma Profiling in Cardiovascular Disease.
http://ift.tt/2oZkRaA
Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.
http://ift.tt/2oFgmhW
Gut Microbe-Generated Trimethylamine N-Oxide From Dietary Choline Is Prothrombotic in Subjects.
http://ift.tt/2oFj0Ef
Letter by Downey and Cohen Regarding Article, "Protective Effects of Ticagrelor on Myocardial Injury After Infarction".
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Letter by Fernandez-Jimenez et al Regarding Article, "Protective Effects of Ticagrelor on Myocardial Injury After Infarction".
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Response by Vilahur et al to Letters Regarding Article, "Protective Effects of Ticagrelor on Myocardial Injury After Infarction".
http://ift.tt/2oZqCF3
Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding
This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs).
http://ift.tt/2pbRfFl
Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding
This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs).
http://ift.tt/2pbRfFl
The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia
Source:Auris Nasus Larynx
Author(s): Jeff D. Markey, William G. Morrel, Steven J. Wang, William R. Ryan
ObjectiveCompare the presence and degree of postoperative xerostomia following preservation or excision of the submandibular gland (SMG) during level IB neck dissection (ND) without adjuvant radiation.MethodsRetrospective review with patient questionnaire administered to patients with pT1-2N0 oral squamous cell carcinoma (SCC) who underwent resection and ND with SMG preservation or SMG excision without postoperative radiation from 2011 to 2015. We analyzed an additional control group that was age and gender-matched and had not undergone oral resection or SMG excision. We compared the scores reported by the three groups from three questionnaires: University of Michigan Xerostomia Quality of Life (XeQoL), Short Form-8 (SF-8), and a xerostomia severity scale (XSS). Dry mouth severity (DMS) was calculated based on XSS scores among those complaining of any xerostomia.ResultsEleven SMG preservation group, 14 SMG excision group and 15 control group patients completed the survey. Complication and recurrence rates were comparable among experimental groups. No differences were identified between the two experimental groups for the XeQoL, SF-8, and XSS questionnaires (p=0.96, 0.87, 0.7). Control patients reported less xerostomia on XeQoL (p=0.046) and XSS (p=0.01) compared to the experimental groups combined with no statistical difference in SF-8 scores (p=0.25). No patients in either group developed regional recurrence in level IB.ConclusionSMG preservation, though technically and oncologically sound, does not appear in this study to reduce xerostomia. Oral resection with ND may result in some degree of xerostomia perception.
http://ift.tt/2pbRY9B
Einseitige supraklavikuläre Schwellung in der Schwangerschaft
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-105795
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Einseitige supraklavikuläre Schwellung in der Schwangerschaft
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-105795
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2pcbEu5
Immune complexes induce TNF-α and BAFF production from U937 cells by HMGB1 and RAGE
OBJECTIVE: This study investigated the effects of immune complexes (ICs) on tumor necrosis factor α (TNF-α) and B cell-activating factor (BAFF) production from U937 cells and further explored the mechanism.
MATERIALS AND METHODS: U937 cells were incubated with necrosis supernatant or systemic lupus erythematosus (SLE) sera alone, or their combination. The expression of TNF-α and BAFF was determined by Real-time polymerase chain reaction and enzyme-linked immunosorbent assay. High mobility group box protein 1(HMGB1) A-box was produced by gene recombination. HMGB1 A-box and anti-receptor for advanced glycation end products (RAGE) antibody were adopted in the blocking experiments. The importance of DNA for cytokine induction was investigated by DNase treatment.
RESULTS: The combination of necrosis supernatant and SLE sera induced the expression of TNF-α and BAFF significantly increased compared to necrosis supernatant or SLE sera alone. Recombinant HMGB1 A-box protein was purified, and TNF-α and BAFF production, which were induced by this combination, was blocked via HMGB1 A-box and anti-RAGE antibody. Moreover, we found that DNA component is important for the immunostimulatory activity of this combination.
CONCLUSIONS: ICs containing DNA can promote TNF-α and BAFF production in U937 cells, and this process can be mediated by HMGB1 and RAGE. One possible mechanism of increasing BAFF production in SLE is proposed in this study whereby B cell activation, antibody production and ICs stimulated monocytes may create a vicious cycle that leads to B cell hyperactivity, which can be of importance for SLE etiopathogenesis.
L'articolo Immune complexes induce TNF-α and BAFF production from U937 cells by HMGB1 and RAGE sembra essere il primo su European Review.
http://ift.tt/2pYMajQ
Decreased microRNA-146a in CD4+T cells promote ocular inflammation in thyroid-associated ophthalmopathy by targeting NUMB
OBJECTIVE: The aim of the study was to explore the functional role of miR-146a in CD4+T cells of active thyroid-associated orbitopathy (TAO) patients and to identify the possible molecular mechanism for the modulation of miR-146a in TAO.
PATIENTS AND METHODS: The experimental group collected six cases of peripheral venous blood of patients with active TAO. The healthy control group collected six cases of normal peripheral venous blood. All specimens excluded other eye diseases and autoimmune diseases, tumors, asthma, chronic inflammation, Human Immunodeficiency Virus (HIV), recent history of trauma, infection, and showed normal thyroid function. All patients with active TAO and age- and sex-matched healthy control subjects in this study.
RESULTS: miR-146a is downregulated in active TAO CD4+T cells. NUMB was a target of miR-146a.
CONCLUSIONS: We observed that miR-146a expression was downregulated in CD4+T cells during the active stage of patients with TAO. At the same time, it was found that NUMB can be targeted by miR-146a in CD4+T cells in TAO patients. Decreased microRNA-146a in CD4+T cells promotes ocular inflammation in active TAO by targeting NUMB.
L'articolo Decreased microRNA-146a in CD4+T cells promote ocular inflammation in thyroid-associated ophthalmopathy by targeting NUMB sembra essere il primo su European Review.
http://ift.tt/2opLDtQ
GDF11 does not improve the palmitate induced insulin resistance in C2C12
OBJECTIVE: GDF11 (Growth Differentiation factor 11) has been reported to rejuvenate skeletal muscle, heart and brain in aged mice, and the aged skeletal muscle is closely related to insulin resistance. We wondered whether GDF11 has an effect on skeletal muscle insulin resistance.
MATERIALS AND METHODS: High fat diet induced obese mice with insulin resistance were established in vivo. Palmitate-induced insulin resistance in C2C12 myotubes was established in vitro. The mRNA expression of GDF11, GLUT4, IRS-1 (insulin receptor substrate-1) and PGC-1α (peroxisome proliferator-activated receptor-gamma coactivator 1) were tested by reverse transcriptase-polymerase chain reaction (RT-PCR). The protein level of GDF11 and PGC-1α were detected by Western blot. The glucose uptake was measured by 2NBDG uptake assay.
RESULTS: In high fat diet induced obese mice, both serum level of GDF11 and the expression of GDF11 in skeletal muscle decreased. Similarly, the expression of GDF11 also reduced in palmitate-treated C2C12 myotubes. In vitro, the glucose uptake and the expression of GLUT4, IRS-1 and PGC-1α significantly decreased after palmitate intervention, but GDF11 treatment did not reverse the reduction of glucose uptake and the expression of GLUT4, IRS-1 and PGC-1α in C2C12 myotubes.
CONCLUSIONS: We firstly confirmed that the expression of GDF11 decreased both in the skeletal muscle of obese mice and palmitate-treated myotubes, but supplementation GDF11 does not ameliorate the palmitate-induced insulin resistance in C2C12 myotubes.
L'articolo GDF11 does not improve the palmitate induced insulin resistance in C2C12 sembra essere il primo su European Review.
http://ift.tt/2pYFguB
What chickens might tell us about the MHC class II system
Aimée Parker | Jim Kaufman
http://ift.tt/2oZddNq
Interactions of tetracyclines with ovalbumin, the main allergen protein from egg white: Spectroscopic and electrophoretic studies
Publication date: September 2017
Source:International Journal of Biological Macromolecules, Volume 102
Author(s): Maria Dayanne de A. Dantas, Humberto de Araújo Tenório, Thiago Inácio B. Lopes, Hugo Juarez V. Pereira, Anita J. Marsaioli, Isis M. Figueiredo, Josué Carinhanha Caldas Santos
The interactions of tetracycline (TC), oxytetracycline (OTC) and chlortetracycline (CTC) with ovalbumin (OVA), the main allergen protein of egg white, were investigated by molecular spectroscopy and electrophoresis at three pH conditions (1.5, 4.6 and 7.4). Molecular and synchronous fluorescence, UV-vis spectroscopy, electrophoresis and 1H NMR were used to study the interaction process. Tetracyclines interact with ovalbumin fluorescence by a static quenching mechanism with non-fluorescent complex formation changing the native protein structure. The binding constant (Kb) ranged from 2.11×104 to 58.4×104Lmol−1, and corresponding thermodynamic parameters were measured at different temperatures and pH values. The binding process was spontaneous (ΔG<0), and the magnitude of the interaction increased in the following order: TC<CTC<OTC. Hydrogen, electrostatic, and Van der Waals forces played a major role in stabilizing the complex. The distances between the donor (protein) and receptors (TC, OTC and CTC) were determined by FRET and varied of 2.95–3.52nm. Fe(III) and Zn(II) ions increase the affinities of TC and CTC for OVA, while OTC did not suffer a significant influence by the competitor metallic species evaluated.
Graphical abstract
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Rapid green synthesis of ZnO nanoparticles using a hydroelectric cell without an electrolyte
Publication date: September 2017
Source:Journal of Physics and Chemistry of Solids, Volume 108
Author(s): Jyoti Shah, Ravinder Kumar Kotnala
In this study, zinc oxide (ZnO) nanoparticles were synthesized using a novel environmentally friendly hydroelectric cell without an electrolyte or external current source. The hydroelectric cell comprised a nanoporous Li substituted magnesium ferrite pellet in contact with two electrodes, with zinc as the anode and silver as an inert cathode. The surface unsaturated cations and oxygen vacancies in the nanoporous ferrite dissociated water molecules into hydronium and hydroxide ions when the hydroelectric cell was dipped into deionized water. Hydroxide ions migrated toward the zinc electrode to form zinc hydroxide and the hydronium ions were evolved as H2 gas at the silver electrode. The zinc hydroxide collected as anode mud was converted into ZnO nanoparticles by heating at 250°C. Structural analysis using Raman spectroscopy indicated the good crystallinity of the ZnO nanoparticles according to the presence of a high intensity E2-(high) mode. The nanoparticle size distribution was 5–20nm according to high resolution transmission electron microscopy. An indirect band gap of 2.75eV was determined based on the Tauc plot, which indicated the existence of an interstitial cation level in ZnO. Near band edge and blue emissions were detected in photoluminescence spectral studies. The blue emissions obtained from the ZnO nanoparticles could potentially have applications in blue lasers and LEDs. The ZnO nanoparticles synthesized using this method had a high dielectric constant value of 5 at a frequency of 1MHz, which could be useful for fabricating nano-oscillators. This facile, clean, and cost-effective method obtained a significant yield of 0.017g for ZnO nanoparticles without applying an external current source.
Graphical abstract
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The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia
Compare the presence and degree of postoperative xerostomia following preservation or excision of the submandibular gland (SMG) during level IB neck dissection (ND) without adjuvant radiation.
http://ift.tt/2pYl2kG
The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia
Compare the presence and degree of postoperative xerostomia following preservation or excision of the submandibular gland (SMG) during level IB neck dissection (ND) without adjuvant radiation.
http://ift.tt/2pYl2kG
Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding
Source:American Journal of Otolaryngology
Author(s): Zhong-hai Jin, Zi-Han Lou, Zheng-Cai Lou
ObjectiveThis study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs).Study designA case series with chart review.SettingA tertiary university hospital.Materials and methodsThe clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test.ResultsOne-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P>0.05). However, the average closure time differed significantly between the two groups (P<0.05): 29.4±3.7days for perforations without bleeding and 20.6±9.2days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P<0.01) within 2weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P>0.05) between the groups without and with bleeding within 4weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P=0.0).ConclusionThis study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.
http://ift.tt/2pf89oA
Ovarian cancer stem cells more questions than answers
Source:Seminars in Cancer Biology
Author(s): P.B. Ottevanger
Epithelial ovarian cancer is a highly lethal disease, which is usually diagnosed at a late stage with extensive metastases in the abdominal cavity. Ovarian cancer either develops from the ovarian surface epithelium (OSE) or from serous intra-epithelial carcinoma (STIC). Primary therapy consists of debulking surgery and platinum based chemotherapy. The success of debulking surgery depends on surgical skills but also on the gene signature of the tumour. Debulking surgery combined with first line platinum based chemotherapy, frequently leads to complete remission. However, most ovarian cancers relapse. Once the disease has relapsed, the interval between subsequent therapies decreases steadily due to rapid progression and therapy resistance.Research on therapy resistance of ovarian cancer is frequently devoted to genetic alterations in cancer cells, leading to drug inactivation, enhanced DNA repair mechanisms and intracellular pathway derangements. However the knowledge of ovarian cancer stem cells (OCSC) and the role they play in the development of cancer and therapy resistance is sparse.In this review current knowledge on the characteristics of OCSCs and the micro environmental mechanisms leading to the development or activation of OCSCs resulting in ovarian cancer is reviewed. Moreover the role of OCSC in both surgical and systemic therapy resistance and the relation with epithelial mesenchymal transformation (EMT) is discussed, as are micro-environmental signals leading to OCSC or EMT activation.
http://ift.tt/2oFRlnt
Expanding perspectives on the significance of mitophagy in cancer
Source:Seminars in Cancer Biology
Author(s): Lauren E. Drake, Maya Z. Springer, Logan P. Poole, Casey J. Kim, Kay F. Macleod
Mitophagy is a selective mode of autophagy in which mitochondria are selectively targeted for degradation at the autophagolysosome. Mitophagy is activated by stresses such as hypoxia, nutrient deprivation, DNA damage, inflammation and mitochondrial membrane depolarization and plays a role in maintaining mitochondrial integrity and function. Defects in mitophagy lead to mitochondrial dysfunction that can affect metabolic reprogramming in response to stress, alter cell fate determination and differentiation, which in turn affects disease incidence and etiology, including cancer. Here, we discuss how different mitophagy adaptors and modulators, including Parkin, BNIP3, BNIP3L, p62/SQSTM1 and OPTN, are regulated in response to physiological stresses and deregulated in cancers. Additionally, we explore how these different mitophagy control pathways coordinate with each other. Finally, we review new developments in understanding how mitophagy affects stemness, cell fate determination, inflammation and DNA damage responses that are relevant to understanding the role of mitophagy in cancer.
http://ift.tt/2pf82sW
Accessibility, Availability, and Potential Benefits of Psycho-Oncology Services: The Perspective of Community-Based Physicians Providing Cancer Survivorship Care
Background.
As persons of trust, community-based physicians providing survivorship care (e.g., general practitioners [GPs]) often serve as the primary contacts for cancer survivors disclosing distress. From the perspective of physicians providing survivorship care for cancer patients, this study explores (a) the accessibility, availability, and potential benefits of psycho-oncology services; (b) whether physicians themselves provide psychosocial support; and (c) predictors for impeded referrals of survivors to services.
Methods.In a cross-sectional survey, all GPs and community-based specialists in a defined region were interviewed. In addition to descriptive analyses, categorical data were investigated by applying chi-square tests. Predictors for impeded referrals were explored through logistic regression.
Results.Of 683 responding physicians, the vast majority stated that survivors benefit from psycho-oncology services (96.8%), but the physicians also articulated that insufficient coverage of psycho-oncology services (90.9%) was often accompanied by impeded referrals (77.7%). A substantial proportion (14.9%) of physicians did not offer any psychosocial support. The odds of physicians in rural areas reporting impeded referrals were 1.91 times greater than the odds of physicians in large urban areas making a similar report (95% confidence interval [1.07, 3.40]).
Conclusion.Most community-based physicians providing survivorship care regard psycho-oncology services as highly beneficial. However, a large number of physicians report tremendous difficulty referring patients. Focusing on those physicians not providing any psychosocial support, health policy approaches should specifically (a) raise awareness of the role of physicians as persons of trust for survivors, (b) highlight the effectiveness of psycho-oncology services, and (c) encourage a proactive attitude toward the assessment of unmet needs and the initiation of comprehensive care. The Oncologist 2017;22:1–9
Implications for Practice: Community-based physicians providing survivorship care for cancer patients regard psycho-oncology services as a highly reasonable and beneficial addition to medical care. In light of insufficient local coverage with services, difficulties with seamless referrals constitute a major challenge for physicians. Apart from emphasizing the effectiveness of psycho-oncology services and proactive attitudes toward the assessment of unmet needs, future policies should focus on the integration of medical and psychosocial follow-up of cancer survivors, especially in rural areas.
http://ift.tt/2pZagOc
A Systematic Review of Strategies to Prevent Cisplatin-Induced Nephrotoxicity
Introduction.
Cisplatin, a platinum-based antineoplastic agent, is the cornerstone for the treatment of many malignancies. Nephrotoxicity is the primary dose-limiting toxicity, and various hydration regimens and supplementation strategies are used to prevent cisplatin-induced kidney injury. However, evidence-based recommendations on specific hydration regimens are limited. A systematic review was performed to evaluate clinical studies that have examined hydration and supplementation strategies to prevent cisplatin-induced nephrotoxicity.
Materials and Methods.PubMed and Excerpta Medica databases were searched from 1966 through October 2015 for clinical trials and other studies focused on hydration regimens to prevent nephrotoxicity in cancer patients treated with cisplatin. The University of Oxford Centre for Evidence-Based Medicine criteria were used to grade level of evidence.
Results.Among the 1,407 identified studies, 24 were included in this systematic review. All studies differed on type, volume, and duration of hydration. Among the 24 studies, 5 evaluated short-duration hydration, 4 evaluated low-volume hydration, 4 investigated magnesium supplementation, and 7 reviewed forced diuresis with hydration. Short-duration and lower-volume hydration regimens are effective in preventing cisplatin-induced nephrotoxicity. Magnesium supplementation may have a role as a nephroprotectant, and forced diuresis may be appropriate in some patients receiving cisplatin.
Conclusion.Hydration is essential for all patients to prevent cisplatin-induced nephrotoxicity. Specifically, short-duration, low-volume, outpatient hydration with magnesium supplementation and mannitol forced diuresis (in select patients) represent best practice principles for the safe use of cisplatin. The Oncologist 2017;22:1–12
Implications for Practice: The findings contained within this systematic review show that (a) hydration is essential for all patients to prevent cisplatin-induced nephrotoxicity, (b) short-duration, low-volume, outpatient hydration regimens appear to be safe and feasible, even in patients receiving intermediate- to high-dose cisplatin, (c) magnesium supplementation (8–16 milliequivalents) may limit cisplatin-induced nephrotoxicity, and (d) mannitol may be considered for high-dose cisplatin and/or patients with preexisting hypertension. These findings have broad implications for clinical practice and represent best practice principles for the prevention of cisplatin-induced nephrotoxicity.
http://ift.tt/2pZsz5B
Prognostic Nomograms Stratify Survival of Patients with Hepatocellular Carcinoma Without Portal Vein Tumor Thrombosis After Curative Resection
Background.
The prognosis of patients with hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT) after curative resection is at variance. We identified the risk factors of poor postoperative prognosis and consequently developed prognostic nomograms generating individual risk of death and recurrence for this subgroup of patients with HCC.
Methods.The risk factors were identified and nomograms were developed based on a retrospective study of 734 patients in the primary cohort who underwent curative resection for HCC from 2010 to 2012. The predictive accuracy and discriminative ability of the nomograms were determined by concordance index (C-index) and calibration curve and compared with traditional staging systems of HCC. The results were validated in an independent cohort of 349 patients operated at the same institution in 2007.
Results.All of the independent factors for survival in multivariate analysis in the primary cohort were selected into the nomograms. The calibration curve for probability of survival showed good agreement between prediction by nomograms and actual observation. The C-indices of the nomograms for predicting overall survival and recurrence-free survival were 0.755 (95% confidence interval [CI], 0.752–0.758) and 0.665 (95% CI, 0.662–0.668), respectively, which were statistically higher than the C-indices of other HCC prognostic models. The results were further confirmed in the validation cohort.
Conclusion.The proposed nomograms resulted in more accurate prognostic prediction for patients with HCC without PVTT after curative resection. The Oncologist 2017;22:1–8
Implications for Practice: Hepatocellular carcinoma (HCC) poses a great therapeutic challenge due to the poor prognosis in patients underwent surgical resection. The portal vein tumor thrombosis (PVTT) as a robust risk factor for survival has been routinely integrated to staging systems. Nonetheless, the prognosis stratification for patients without PVTT was neglected to some extent. Herein, independent risk factors of OS and RFS in HCC patients without PVTT were reconfirmed. A predictive nomogram was constructed on these risk factors and was demonstrated to be a more accurate predictive model in HCC patients without PVTT, compared with the traditional staging systems.
http://ift.tt/2pbQTyA
FDA Approval Summary: Nivolumab for the Treatment of Relapsed or Progressive Classical Hodgkin Lymphoma
On May 17, 2016, after an expedited priority review, the U.S. Food and Drug Administration granted accelerated approval to nivolumab for the treatment of patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after autologous hematopoietic stem cell transplantation (HSCT) and post-transplantation brentuximab vedotin (BV). Nivolumab in cHL had been granted breakthrough therapy designation. Accelerated approval was based on two single-arm, multicenter trials in adults with cHL. In 95 patients with relapsed or progressive cHL after autologous HSCT and post-transplantation BV, nivolumab, dosed at 3 mg/kg intravenously every 2 weeks, produced a 65% (95% confidence interval: 55%–75%) objective response rate (58% partial remission, 7% complete remission). The estimated median duration of response was 8.7 months, with 4.6-month median follow-up for response duration. The median time to response was 2.1 (range: 0.7–5.7) months. Among 263 patients with cHL treated with nivolumab, 21% reported serious adverse reactions (ARs). The most common all-grade ARs (reported in ≥20%) were fatigue, upper respiratory tract infection, cough, pyrexia, diarrhea, elevated transaminases, and cytopenias. Infusion-related reaction and hypothyroidism or thyroiditis occurred in >10% of patients; other immune-mediated ARs, occurring in 1%–5%, included rash, pneumonitis, hepatitis, hyperthyroidism, and colitis. A new Warning and Precaution was issued for complications of allogeneic HSCT after nivolumab, including severe or hyperacute graft-versus-host disease, other immune-mediated ARs, and transplant-related mortality. Continued approval for the cHL indication may be contingent upon verification of clinical benefit in a randomized trial. The Oncologist 2017;22:1–7
Implications for Practice: Based on response rate and duration in single-arm studies, nivolumab is a new treatment option for patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed despite autologous hematopoietic stem cell transplantation (HSCT) and brentuximab vedotin. This was the first U.S. Food and Drug Administration marketing application for a programmed cell death 1 inhibitor in hematologic malignancies. The use of immune checkpoint blockade in cHL represents a new treatment paradigm. The safety of allogeneic HSCT after nivolumab requires further evaluation, as does the safety of nivolumab after allogeneic HSCT.
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Corrigendum to “Oldenlandia diffusa suppresses metastatic potential through inhibiting matrix metalloproteinase-9 and intercellular adhesion molecule-1 expression via p38 and ERK1/2 MAPK pathways and induces apoptosis in human breast cancer MCF-7 cells” [J. Ethnopharmacol. 195 (2017) 309–317]
Publication date: Available online 24 April 2017
Source:Journal of Ethnopharmacology
Author(s): Tae-Wook Chung, Hyunju Choi, Ji-Min Lee, Sun-Hyung Ha, Choong-Hwan Kwak, Fukushi Abekura, Jun-Young Park, Young-Chae Chang, Ki-Tae Ha, Seung-Hak Cho, Hyeun Wook Chang, Young-Choon Lee, Cheorl-Ho Kim
http://ift.tt/2oFV44q
IFC (Ed. Board)
Source:Brain Research Bulletin, Volume 130
http://ift.tt/2q8qQY8
Local energy on demand: are ‘spontaneous’ astrocytic Ca2+-microdomains the regulatory unit for astrocyte-neuron metabolic cooperation?
Source:Brain Research Bulletin
Author(s): Martin Oheim, Elke Schmidt, Johannes Hirrlinger
Astrocytes are a neural cell type critically involved in maintaining brain energy homeostasis as well as signaling. Like neurons, astrocytes are a heterogeneous cell population. Cortical astrocytes show a complex morphology with a highly branched aborization and numerous fine processes ensheathing the synapses of neighboring neurons, and typically extend one process connecting to blood vessels. Recent studies employing genetically encoded fluorescent calcium (Ca2+) indicators have described 'spontaneous' localized Ca2+-transients in the astrocyte periphery that occur asynchronously, independently of signals in other parts of the cells, and that do not involve somatic Ca2+ transients; however, neither it is known whether these Ca2+-microdomains occur at or near neuronal synapses nor have their molecular basis nor downstream effector(s) been identified. In addition to Ca2+ microdomains, sodium (Na+) transients occur in astrocyte subdomains, too, most likely as a consequence of Na+ co-transport with the neurotransmitter glutamate, which also regulates mitochondrial movements locally − as do cytoplasmic Ca2+ levels.In this review, we cover various aspects of these local signaling events and discuss how structural and biophysical properties of astrocytes might foster such compartmentation. Astrocytes metabolically interact with neurons by providing energy substrates to active neurons. As a single astrocyte branch covers hundreds to thousands of synapses, it is tempting to speculate that these metabolic interactions could occur localized to specific subdomains of astrocytes, perhaps even at the level of small groups of synapses. We discuss how astrocytic metabolism might be regulated at this scale and which signals might contribute to its regulation. We speculate that the astrocytic structures that light up transiently as Ca2+-microdomains might be the functional units of astrocytes linking signaling and metabolic processes to adapt astrocytic function to local energy demands. The understanding of these local regulatory and metabolic interactions will be fundamental to fully appreciate the complexity of brain energy homeostasis as well as its failure in disease and may shed new light on the controversy about neuron-glia bi-directional signaling at the tripartite synapse.
http://ift.tt/2ptUJ9d
Whole-body vibration induces distinct reflex patterns in human soleus muscle
Publication date: Available online 24 April 2017
Source:Journal of Electromyography and Kinesiology
Author(s): Ilhan Karacan, Muharrem Cidem, Mehmet Cidem, Kemal S. Türker
The neuronal mechanisms underlying whole body vibration (WBV)-induced muscular reflex (WBV-IMR) are not well understood. To define a possible pathway for WBV-IMR, this study investigated the effects of WBV amplitude on WBV-IMR latency by surface electromyography analysis of the soleus muscle in human adult volunteers. The tendon (T) reflex was also induced to evaluate the level of presynaptic Ia inhibition during WBV. WBV-IMR latency was shorter when induced by low- as compared to medium- or high-amplitude WBV (33.9 ± 5.3 ms vs. 43.8 ± 3.6 and 44.1 ± 4.2 ms, respectively). There was no difference in latencies between T-reflex elicited before WBV (33.8 ± 2.4 ms) and WBV-IMR induced by low-amplitude WBV. Presynaptic Ia inhibition was absent during low-amplitude WBV but was present during medium- and high-amplitude WBV. Consequently, WBV induces short- or long-latency reflexes depending on the vibration amplitude. During low-amplitude WBV, muscle spindle activation may induce the short- but not the long-latency WBV-IMR. Furthermore, unlike the higher amplitude WBV, low-amplitude WBV does not induce presynaptic inhibition at the Ia synaptic terminals.
http://ift.tt/2pZk5eI
The Impact of Oral Promethazine on Human Whole-Body Motion Perceptual Thresholds
Abstract
Despite the widespread treatment of motion sickness symptoms using drugs and the involvement of the vestibular system in motion sickness, little is known about the effects of anti-motion sickness drugs on vestibular perception. In particular, the impact of oral promethazine, widely used for treating motion sickness, on vestibular perceptual thresholds has not previously been quantified. We examined whether promethazine (25 mg) alters vestibular perceptual thresholds in a counterbalanced, double-blind, within-subject study. Thresholds were determined using a direction recognition task (left vs. right) for whole-body yaw rotation, y-translation (interaural), and roll tilt passive, self-motions. Roll tilt thresholds were 31 % higher after ingestion of promethazine (P = 0.005). There were no statistically significant changes in yaw rotation and y-translation thresholds. This worsening of precision could have functional implications, e.g., during driving, bicycling, and piloting tasks. Differing results from some past studies of promethazine on the vestibulo-ocular reflex emphasize the need to study motion perception in addition to motor responses.
http://ift.tt/2psW28s
A Year Later: Lessons Learned
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
Author(s): Lucille Beseler
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Psyllium Husk Should Be Taken at Higher Dose with Sufficient Water to Maximize Its Efficacy
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
Author(s): Pankaj Garg
http://ift.tt/2pevYNt
Table of Contents
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
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Author’s Response
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
Author(s): Johnson W. McRorie, Nicola M. McKeown
http://ift.tt/2paWvJa
Academy Approves NIAID Addendum Guidelines for the Prevention of Peanut Allergy
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
Author(s): Lisa Moloney, Donna L. Wickstrom, Marsha Schofield, Rosa K. Hand
http://ift.tt/2pb9meF
Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Summary of the National Institute of Allergy and Infectious Diseases–Sponsored Expert Panel
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
Author(s): Alkis Togias, Susan F. Cooper, Maria L. Acebal, Amal Assa'ad, James R. Baker, Lisa A. Beck, Julie Block, Carol Byrd-Bredbenner, Edmond S. Chan, Lawrence F. Eichenfield, David M. Fleischer, George J. Fuchs, Glenn T. Furuta, Matthew J. Greenhawt, Ruchi S. Gupta, Michele Habich, Stacie M. Jones, Kari Keaton, Antonella Muraro, Marshall Plaut, Lanny J. Rosenwasser, Daniel Rotrosen, Hugh A. Sampson, Lynda C. Schneider, Scott H. Sicherer, Robert Sidbury, Jonathan Spergel, David R. Stukus, Carina Venter, Joshua A. Boyce
http://ift.tt/2peCZ0r
Information for Authors
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
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May 2017 People & Events
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
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May 2017 New in Review
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
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May 2017 Classified Advertisements
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
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Methylmercury and Seafood: What Are the Latest Guidelines?
Source:Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5
Author(s): Eleese Cunningham
http://ift.tt/2peCROv
Targeting DNA damage response systems to impact cancer care
Source:Current Problems in Cancer
Author(s): Joaquin Mateo, Johann S. de Bono
http://ift.tt/2ooVG2A
Impact of a risk-based follow-up in patients affected by gastrointestinal stromal tumour
Source:European Journal of Cancer, Volume 78
Author(s): Lorenzo D'Ambrosio, Erica Palesandro, Paola Boccone, Francesco Tolomeo, Sara Miano, Danilo Galizia, Antonio Manca, Gabriele Chiara, Ilaria Bertotto, Filippo Russo, Delia Campanella, Tiziana Venesio, Dario Sangiolo, Ymera Pignochino, Dimitrios Siatis, Michele De Simone, Alessandro Ferrero, Alberto Pisacane, Angelo Paolo Dei Tos, Sandra Aliberti, Massimo Aglietta, Giovanni Grignani
BackgroundFollow-up aims to precociously identify recurrences, metastases or treatment-related adverse events so as to undertake the appropriate therapy. Guidelines admit lack of knowledge on optimal surveillance schedule, but suggest follow-up based on experts' opinion and risk stratification. To identify the impact, if any, of regular follow-up, we interrogated our prospectively collected database whether early detection of recurrences affected both clinical management and, likely, the outcome.Patients and methodsWe required information to be available on primary surgery and ≥3°years of follow-up for non-recurring patients. We analysed recurrence characteristics (asymptomatic versus symptomatic, low- versus high tumour burden) and computed tomography (CT) scan counts to detect one recurrence. Kaplan–Meier method estimated recurrence-free survival (RFS), post-recurrence progression-free survival (PR-PFS), and disease-specific overall survival (OS). Comparisons used Hazard ratios (HR) with 95% confidence intervals (CIs). Multivariate analyses employed the Cox proportional hazards model. All tests were two-sided.ResultsBetween 01/2001 and 12/2012 we found 233 study-eligible patients. Estimated 5- and 10-year RFS were 61.8% and 50.4%, respectively. After a 68-month median follow-up, we observed 94 (40.3%) recurrences [73/94 (77.7%) asymptomatic versus 21/94 (22.3%) symptomatic and 45/94 (47.9%) low- versus 49/94 (52.1%) high tumour burden]. Multivariate analysis revealed that symptomatic and high tumour burden recurrences were highly predictive of both worse PR-PFS (HR:3.19, P < 0.001; HR:2.80, P = 0.003, respectively) and OS (HR:3.65, P < 0.001; HR:2.38, P = 0.026, respectively). Finally, 29 second (primary) cancers were detected during follow-up.ConclusionsRegular follow-up detects recurrences at an earlier stage and may be associated with a better PR-PFS and OS for these patients. In the absence of randomised trials, these evidences support follow-up effort and cost.
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Systemic mastocytosis with KIT V560G mutation presenting as recurrent episodes of vascular collapse: response to disodium cromoglycate and disease outcome
Mastocytosis are rare diseases characterized by an accumulation of clonal mast cells (MCs) in one or multiple organs or tissues. Patients with systemic mastocytosis (SM), whose MCs frequently arbor the activat...
http://ift.tt/2paTEzU
Systemic mastocytosis with KIT V560G mutation presenting as recurrent episodes of vascular collapse: response to disodium cromoglycate and disease outcome
Mastocytosis are rare diseases characterized by an accumulation of clonal mast cells (MCs) in one or multiple organs or tissues. Patients with systemic mastocytosis (SM), whose MCs frequently arbor the activat...
http://ift.tt/2paTEzU
Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease
AbstractBackground
In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated.
ObjectivesThe purpose of this study was to evaluate EM after catheter ablation of scar-related VT.
MethodsAssociations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers.
ResultsOf 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001).
ConclusionsIn a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.
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Transcatheter Mitral Valve Replacement: Insights From Early Clinical Experience and Future Challenges
Abstract
Transcatheter mitral valve repair, particularly edge-to-edge leaflet repair, is a well-established alternative for patients with severe primary mitral regurgitation (MR) considered at high or prohibitive surgical risk. More recently, transcatheter mitral valve replacement (TMVR) has emerged as a potential therapeutic option for the treatment of severe MR. TMVR may offer some advantages over transcatheter repair by providing a more complete and reproducible MR reduction. Several devices are under preclinical and clinical evaluation, and the early experience with more than 100 patients has demonstrated the feasibility of TMVR. In this review, we describe the TMVR systems currently in development and the results obtained from early clinical experiences. We also discuss the main challenges in and future perspectives on this emerging field. Future studies with a much larger number of patients are needed to provide consistent safety and efficacy data on each of the TMVR systems.
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Cardiac Resynchronization Therapy With Wireless Left Ventricular Endocardial Pacing: The SELECT-LV Study
AbstractBackground
A total of 30% to 40% of patients with congestive heart failure eligible for cardiac resynchronization therapy (CRT) either do not respond to conventional CRT or remain untreated due to an inability or impediment to coronary sinus (CS) lead implantation. The WiSE-CRT system (EBR Systems, Sunnyvale, California) was developed to address this at-risk patient population by performing biventricular pacing via a wireless left ventricular (LV) endocardial pacing electrode.
ObjectivesThe SELECT-LV (Safety and Performance of Electrodes implanted in the Left Ventricle) study is a prospective multicenter non-randomized trial assessing the safety and performance of the WiSE-CRT system.
MethodsA total of 35 patients indicated for CRT who had "failed" conventional CRT underwent implantation of an LV endocardial pacing electrode and a subcutaneous pulse generator. System performance, clinical efficacy, and safety events were assessed out to 6 months post-implant.
ResultsThe procedure was successful in 97.1% (n = 34) of attempted implants. The most common indications for endocardial LV pacing were difficult CS anatomy (n =12), failure to respond to conventional CRT (n = 10), and a high CS pacing threshold or phrenic nerve capture (n = 5). The primary performance endpoint, biventricular pacing on the 12-lead electrocardiogram at 1 month, was achieved in 33 of 34 patients. A total of 28 patients (84.8%) had improvement in the clinical composite score at 6 months, and 21 (66%) demonstrated a positive echocardiographic CRT response (≥5% absolute increase in LV ejection fraction). There were no pericardial effusions, but serious procedure/device-related events occurred in 3 patients (8.6%) within 24 h, and 8 patients (22.9%) between 24 h and 1 month.
ConclusionsThe SELECT-LV study demonstrates the clinical feasibility for the WiSE-CRT system, and provided clinical benefits to a majority of patients within an otherwise "failed" CRT population. (Safety and Performance of Electrodes Implanted in the Left Ventricle [SELECT-LV]; NCT01905670)
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ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Tho
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Utility of Post-Mortem Genetic Testing in Cases of Sudden Arrhythmic Death Syndrome
AbstractBackground
Sudden arrhythmic death syndrome (SADS) describes a sudden death with negative autopsy and toxicological analysis. Cardiac genetic disease is a likely etiology.
ObjectivesThis study investigated the clinical utility and combined yield of post-mortem genetic testing (molecular autopsy) in cases of SADS and comprehensive clinical evaluation of surviving relatives.
MethodsWe evaluated 302 expertly validated SADS cases with suitable DNA (median age: 24 years; 65% males) who underwent next-generation sequencing using an extended panel of 77 primary electrical disorder and cardiomyopathy genes. Pathogenic and likely pathogenic variants were classified using American College of Medical Genetics (ACMG) consensus guidelines. The yield of combined molecular autopsy and clinical evaluation in 82 surviving families was evaluated. A gene-level rare variant association analysis was conducted in SADS cases versus controls.
ResultsA clinically actionable pathogenic or likely pathogenic variant was identified in 40 of 302 cases (13%). The main etiologies established were catecholaminergic polymorphic ventricular tachycardia and long QT syndrome (17 [6%] and 11 [4%], respectively). Gene-based rare variants association analysis showed enrichment of rare predicted deleterious variants in RYR2 (p = 5 x 10-5). Combining molecular autopsy with clinical evaluation in surviving families increased diagnostic yield from 26% to 39%.
ConclusionsMolecular autopsy for electrical disorder and cardiomyopathy genes, using ACMG guidelines for variant classification, identified a modest but realistic yield in SADS. Our data highlighted the predominant role of catecholaminergic polymorphic ventricular tachycardia and long QT syndrome, especially the RYR2 gene, as well as the minimal yield from other genes. Furthermore, we showed the enhanced utility of combined clinical and genetic evaluation.
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Bioprosthetic Valve Thrombosis
Abstract
Bioprosthetic valve (BPV) thrombosis is considered a relatively rare clinical entity. Yet a more recent analysis involving a more systematic echocardiographic follow-up, the advent of transcatheter heart valve (THV) technologies coupled with the highly sensitive nature of 4-dimensional computed tomographic imaging for detecting subclinical thrombi upon both surgically implanted and THVs, has generated enormous interest in this field, casting new light on both its true incidence and clinical relevance. Debate continues among clinicians as to both the clinical relevance of subclinical BPV thrombosis and the value of empirical oral anticoagulation following BPV implantation. Furthermore, currently no systematic, prospective data exist regarding the optimal treatment approach in THV recipients. The authors provide an overview of the clinical and subclinical spectrum of BPV thrombosis of surgical and THVs, outline its diagnostic challenges, summarize its pathophysiological basis, and discuss various therapeutic options that are emerging, particularly within the rapidly expanding field of THV implantation.
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