Ganglioneuroblastoma is a tumor of peripheral neuroblastic tissue which occurs predominantly in the pediatric age group; it is a rare occurrence in the newborn period with only one case reported at birth to date.
http://ift.tt/2wkbnZC
Δευτέρα 28 Αυγούστου 2017
Ganglioneuroblastoma in a newborn with multiple metastases: a case report
Ganglioneuroblastoma in a newborn with multiple metastases: a case report
Ganglioneuroblastoma is a tumor of peripheral neuroblastic tissue which occurs predominantly in the pediatric age group; it is a rare occurrence in the newborn period with only one case reported at birth to date.
http://ift.tt/2wkbnZC
Takayasu arteritis presenting as embolic stroke
A 52-year-old Caucasian woman presented to the emergency department with symptoms of acute ischaemic stroke (right-side weakness, confusion and aphasia) that resolved completely after administration of tissue plasminogen activator. During stroke work-up, she was found to have an enhancing infiltrate of the aorta at the level of the take-off of the great vessels, most consistent with early Takayasu arteritis. After being discharged home on steroids and dual antiplatelet therapy, she returned 2 days later with re-presentation of weakness and aphasia. Further work-up revealed two intraluminal clots in the left common carotid and left internal carotid arteries that had not been discovered during previous testing. This case illustrates the need to screen for sources of embolic stroke in patients with Takayasu arteritis, especially those with recurring symptoms.
http://ift.tt/2iDQwwR
Oesophageal mastocytosis: eosinophilic oesophagitis without eosinophils?
A 59-year-old male with a history of lifelong asthma, allergic rhinitis and hypercholesterolaemia presented to the emergency department for management of severe substernal chest pain with radiating pain to his left arm, nausea and diaphoresis. Physical examination was unrevealing and a cardiac workup including cardiac enzymes, ECG, chest radiographs were negative for an underlying ischaemic event. A subsequent gastrointestinal workup including oesophageal manometry and oesophagogastroduodenoscopy revealed elevated lower oesophageal pressures and histopathology suggestive of mast cell proliferation, respectively. These findings were suggestive of oesophageal mastocytosis. Treatment with omeprazole-sodium bicarbonate, cetirizine, montelukast and oral budesonide promptly ameliorated his symptoms which have not recurred.
http://ift.tt/2gkQLMG
Continuous remission of renal cell carcinoma with tumour thrombus after severe adverse events following short-term treatment with sunitinib
A 64-year-old Japanese man with renal cell carcinoma (RCC) and tumour thrombus in the inferior vena cava was treated with sunitinib. Two weeks after treatment, he was hospitalised for disturbance of consciousness. Laboratory tests revealed high-grade hypoglycaemia, hyponatraemia, liver dysfunction and thrombocytopaenia with disseminated intravascular coagulation. Sunitinib was discontinued and the patient recovered after a protracted platelet transfusion. At 5 months after treatment, CT revealed that the tumour thrombus had disappeared and other lesions had regressed. MRI at 15 months revealed further regression and suggested the possibility of histological remission according to the signal intensity of fibrosis. A partial response persisted at 20 months after treatment, despite residual accumulation in the renal tumour evident on positron emission tomography. In summary, we present a case of locally advanced RCC accompanied by severe adverse events that showed a significant and durable response to treatment with sunitinib for just 2 weeks.
http://ift.tt/2iDQg0R
Autoinflammatory Diseases in Pediatric Dermatology-Part 1: Urticaria-like Syndromes, Pustular Syndromes, and Mucocutaneous Ulceration Syndromes
Autoinflammatory Diseases in Pediatric Dermatology–Part 2: Histiocytic, Macrophage Activation, and Vasculitis Syndromes
Diagnostic and Prognostic Relevance of the Cutaneous Manifestations of Neurofibromatosis Type 2
Impact of Vitiligo on Quality of Life
Treatment of Human Scabies with Oral Ivermectin. Eczematous Eruptions as a New Non-Reported Adverse Event
Reliability of the MDi Psoriasis Application to Aid Therapeutic Decision-Making in Psoriasis
Acral Hemorrhagic Darier Disease
A reddish plaque in the forehead
Slow-Growing Keratotic Tumor on the Eyelid
RF-Acral Melanoma and Repetitive Injury to the Sole of the Foot
Coexistence of Sutton and Meyerson Nevi
Isolated Anterior Cervical Hypertrichosis
Edematous Dermatomyositis with Probable Evans Syndrome
Reticulate Acropigmentation of Kitamura and Nevus of Ito
Melanomas Arising on Tattoos: A Casual Association with Practical Implications
Aspirin Monotherapy Should Not Be Recommended for Cardioprotection in Patients With Symptomatic Peripheral Artery Disease.
Author: Brass, Eric P. MD, PhD; Hiatt, William R. MD
Page: 785-786
http://ift.tt/2vEPjGS
Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair.
Author: The MA3RS Study Investigators
Page: 787-797
http://ift.tt/2vn5Vba
Incident Cardiovascular Disease Among Adults With Blood Pressure
Author: Tajeu, Gabriel S. DrPH; Booth, John N. III PhD; Colantonio, Lisandro D. MD, PhD; Gottesman, Rebecca F. MD, PhD; Howard, George DrPH; Lackland, Daniel T. DrPH; O'Brien, Emily C. PhD; Oparil, Suzanne MD; Ravenell, Joseph MD; Safford, Monika M. MD; Seals, Samantha R. PhD; Shimbo, Daichi MD; Shea, Steven MD; Spruill, Tanya M. MD; Tanner, Rikki M. PhD; Muntner, Paul PhD
Page: 798-812
http://ift.tt/2vEWkaL
Maximizing Cardiovascular Event Reduction by Expanding and Intensifying the Targets.
Author: Ziaeian, Boback MD, PhD; Fonarow, Gregg C. MD
Page: 813-816
http://ift.tt/2vn5UUE
Platelets Express Activated P2Y12 Receptor in Patients With Diabetes Mellitus.
Author: Hu, Liang PhD; Chang, Lin BS; Zhang, Yan MD, PhD; Zhai, Lili MS; Zhang, Shenghui MD, PhD; Qi, Zhiyong MD; Yan, Hongmei MD, PhD; Yan, Yan MD, PhD; Luo, Xinping MD, PhD; Zhang, Si MD, PhD; Wang, Yiping PhD; Kunapuli, Satya P. PhD; Ye, Hongying MD, PhD; Ding, Zhongren MD, PhD
Page: 817-833
http://ift.tt/2vEPhyK
Dedifferentiation, Proliferation, and Redifferentiation of Adult Mammalian Cardiomyocytes After Ischemic Injury.
Author: Wang, Wei Eric MD, PhD *; Li, Liangpeng MD *; Xia, Xuewei MS *; Fu, Wenbin MD; Liao, Qiao MS; Lan, Cong MD; Yang, Dezhong MD; Chen, Hongmei MD; Yue, Rongchuan MD, PhD; Zeng, Cindy; Zhou, Lin MD, PhD; Zhou, Bin PhD; Duan, Dayue Darrel MD, PhD; Chen, Xiongwen PhD; Houser, Steven R. PhD; Zeng, Chunyu MD, PhD
Page: 834-848
http://ift.tt/2vnc7zJ
Cardiovascular Actions and Clinical Outcomes With Glucagon-Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors.
Author: Nauck, Michael A. MD; Meier, Juris J. MD; Cavender, Matthew A. MD, MPH; Abd El Aziz, Mirna MD; Drucker, Daniel J. MD
Page: 849-870
http://ift.tt/2vEHYap
A Lead to the Culprit.
Author: Rahman, Haseeb BMBCh; Modi, Bhavik MBBS; Ellis, Howard BSc; Arri, Satpal MBBS; Perera, Divaka MD
Page: 877-879
http://ift.tt/2vEKwW6
The Low-Density Lipoprotein Receptor Genotype Is a Significant Determinant of the Rebound in Low-Density Lipoprotein Cholesterol Concentration After Lipoprotein Apheresis Among Patients With Homozygous Familial Hypercholesterolemia.
Author: Drouin-Chartier, Jean-Philippe MSc; Tremblay, Andre J. PhD; Bergeron, Jean MD, MSc; Lamarche, Benoit PhD; Couture, Patrick MD, PhD
Page: 880-882
http://ift.tt/2vnc4E3
Letter by Gabet et al Regarding Article, "Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012".
Author: Gabet, Amelie MS; Juilliere, Yves MD; Olie, Valerie PhD
Page: 883
http://ift.tt/2vFyX0Q
Letter by Kaul et al Regarding Article, "Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012".
Author: Kaul, Padma PhD; Ezekowitz, Justin A. MD; McAlister, Finlay A. MD
Page: 884-885
http://ift.tt/2vn8DgG
Response by Christiansen et al to Letters Regarding Article, "Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012".
Author: Christiansen, Mia Nielsen MD; Kober, Lars MD, DSc; Andersson, Charlotte MD, PhD
Page: 886-887
http://ift.tt/2vEROcb
Multiple correspondence analysis as a strategy to explore the association between categories of qualitative variables related to oral–maxillofacial trauma and violent crimes at the community level
The main objective of this study was to show the applicability of multiple correspondence analysis (MCA) in the detection and representation of underlying structures in large datasets used to investigate oral–maxillofacial lesions. A cross-sectional study was conducted involving the analysis of the medical–forensic and social records of 992 people who experienced oral–maxillofacial trauma resulting from non-fatal violent crimes that occurred in the community. Based on the MCA results, two distinct victim profiles were identified.
http://ift.tt/2wjX6vI
Adjuvant radiation and survival following surgical resection of sinonasal melanoma
Surgery remains the mainstay of treatment for sinonasal melanoma, but it is often difficult to obtain clear, negative margins. Therefore, patients often receive adjuvant radiation therapy (RT), however its impact on overall survival (OS) is not well understood.
http://ift.tt/2wdMIav
Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life
Chronic hyperplasia of the inferior nasal concha is accompanied by a nasal obstruction; however, there is no standardised surgical treatment for this condition. Here, we compared the outcome of three surgical techniques frequently used to treat the hyperplasia of inferior turbinates: turbinectomy with lateralization, submucosal electrocautery and laser cautery additional to septoplasty.
http://ift.tt/2xsQuvk
Adjuvant radiation and survival following surgical resection of sinonasal melanoma
Surgery remains the mainstay of treatment for sinonasal melanoma, but it is often difficult to obtain clear, negative margins. Therefore, patients often receive adjuvant radiation therapy (RT), however its impact on overall survival (OS) is not well understood.
http://ift.tt/2wdMIav
Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life
Chronic hyperplasia of the inferior nasal concha is accompanied by a nasal obstruction; however, there is no standardised surgical treatment for this condition. Here, we compared the outcome of three surgical techniques frequently used to treat the hyperplasia of inferior turbinates: turbinectomy with lateralization, submucosal electrocautery and laser cautery additional to septoplasty.
http://ift.tt/2xsQuvk
Success rates and complications of autologous onlay bone grafts and sinus lifts in patients with congenital hypodontia and after trauma
Autogenous bone remains the gold standard for augmentation of the alveolar ridge in congenital hypodontia and appreciable post-traumatic deformity. This generally reflects the volume of material required for such defects and the osteogenic potential of the grafts. Morbidity at the donor site and success rates may lead to autogenous grafts being superseded by xenografts or alloplastic materials in the future, but we know of little evidence to confirm this. All patients having augmentation of the alveolar ridge or sinus lift to enable subsequent placement of implants between 01 January 2009 and 31 December 2016 were identified from a prospectively-gathered database held at the Queen Elizabeth Hospital, Birmingham.
http://ift.tt/2vyQ8Sn
Histamine and TLR ligands synergistically induce endothelial-cell gap-formation by the extrinsic coagulating pathway
Histamine and LPS synergistically induce the expression of TF by vascular endothelial cells, activating the extrinsic coagulation cascade followed by an increase of vascular permeability.
http://ift.tt/2xI1cxl
Novel Stat1 Mutation Disrupts Small Ubiquitin-Related Modifier (Sumo) Conjugation Causing Gain Of Function
The E705V GOF STAT1 mutation in the consensus motif for sumoylation is associated with the occurrence of CMC, squamous cell carcinoma, and endocrinopathies. This is also the first described association of Rhodococcus equi in GOF STAT1 disease.
http://ift.tt/2xI1aFJ
Emergency consultation for epistaxis: A bad predictor for overall health?
To compare the mortality rate of a large epistaxis cohort with the fatalities of the general Swiss population and to evaluate significant risk factors for impending early death.
http://ift.tt/2xIci5z
Long-term voice outcome after thyroidectomy using energy based devices
Voice dysfunction is frequently reported after thyroidectomy even in absence of vocal fold paralysis. The energy-based devices such as Harmonic scalpel (HS) or LigaSure (LS) are commonly used in conventional thyroidectomy. The objective of this study was to investigate the long-term voice outcome after total thyroidectomy using energy based devices.
http://ift.tt/2wNyZZq
Emergency consultation for epistaxis: A bad predictor for overall health?
To compare the mortality rate of a large epistaxis cohort with the fatalities of the general Swiss population and to evaluate significant risk factors for impending early death.
http://ift.tt/2xIci5z
Long-term voice outcome after thyroidectomy using energy based devices
Voice dysfunction is frequently reported after thyroidectomy even in absence of vocal fold paralysis. The energy-based devices such as Harmonic scalpel (HS) or LigaSure (LS) are commonly used in conventional thyroidectomy. The objective of this study was to investigate the long-term voice outcome after total thyroidectomy using energy based devices.
http://ift.tt/2wNyZZq
Localizing the Lost Rectus Muscle Using the Connective Tissue Framework: Revisiting the Tunnel Technique.
Purpose: To describe a technique for localizing a lost rectus muscle during strabismus or retinal surgery or following trauma. Methods: In this single center, retrospective chart review, 5 patients were identified between January 2012 and June 2016 with a lost rectus muscle; 3 during strabismus surgery and 2 post trauma. The inclusion criteria included a lost rectus muscle during strabismus surgery, or a disinserted/lacerated rectus muscle following ocular/orbital trauma. The primary outcome measure was successful reattachment of the rectus muscle. Results: The lost rectus muscle was identified in each patient and reattached to the globe by gently applying traction anteriorly at the conjunctiva/Tenon edge using double-pronged skin hooks and following the path of the rectus muscle through its Tenon capsule tunnel where it remained attached by suspensory ligaments. There was no instance where orbital fat was obscuring or blocking the view of the lost rectus muscles. There were no other complications associated with the procedure. Conclusions: The authors describe a simple and effective method in 5 patients to localize a lost rectus muscle based on knowledge of the orbital connective tissue framework. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
http://ift.tt/2xsBc9I
http://ift.tt/2xsBc9I
Prepectoral Breast Reconstruction: A Safe Alternative to Submuscular Prosthetic Reconstruction following Nipple-Sparing Mastectomy
http://ift.tt/2vz3o9I
Disclosure of Financial Conflicts of Interest in Plastic and Reconstructive Surgery
http://ift.tt/2vz9irx
Treating Breast Conservation Therapy Defects with Brava and Fat Grafting: Technique, Outcomes, and Safety Profile
http://ift.tt/2wXJuZv
Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination around the Device: Experience in 42,000 Implants
http://ift.tt/2vz2t92
Determining the Oncologic Safety of Autologous Fat Grafting as a Reconstructive Modality: An Institutional Review of Breast Cancer Recurrence Rates and Surgical Outcomes
http://ift.tt/2wY8Gz5
Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?
http://ift.tt/2wY1rHm
Breast Cancer Genetics for Plastic Surgeons
http://ift.tt/2wY5S4Q
Comparison of Endothelial Differentiation Capacities of Human and Rat Adipose-Derived Stem Cells
http://ift.tt/2wY1LpI
Free Diced Cartilage: A New Application of Diced Cartilage Grafts in Primary and Secondary Rhinoplasty
http://ift.tt/2wXOugS
A Safe and Inexpensive Technique for Turbinate Cauterization Surgery
http://ift.tt/2wYbdt7
Discussion: Free Diced Cartilage: A New Application of Diced Cartilage Grafts in Primary and Secondary Rhinoplasty
http://ift.tt/2wXuydM
Introducing the International Confederation of Plastic Surgery Societies: ICOPLAST
http://ift.tt/2wYgrVE
Facial Assessment and Injection Guide for Botulinum Toxin and Injectable Hyaluronic Acid Fillers: Focus on the Lower Face
http://ift.tt/2wY45gu
Cytomegalovirus Viral Load in Bronchoalveolar Lavage to Diagnose Lung Transplant Associated CMV Pneumonia.
Background: The diagnostic yield for cytomegalovirus (CMV) PCR viral load in Bronchoalveolar Lavage (BAL) or in plasma to diagnose CMV pneumonia in lung transplant recipients remains uncertain, and was investigated in a large cohort of consecutive lung transplant recipients. Methods: Bronchoscopies within the first year of lung transplantation with CMV detectable in BAL by PCR (ie, viral load >=273 IU/mL) were included (66 recipients; 145 bronchoscopies); at each bronchoscopy episode 2 independent experts reviewed clinical and laboratory information to determine whether the patient at that time fulfilled the criteria for CMV pneumonia per current international recommendations. Corresponding plasma CMV PCR viral load determined at time of the bronchoscopy (n=126) was also studied. Optimal CMV PCR viral load cut off for CMV pneumonia diagnosis was determined using receiver operating characteristics (ROC). Results: CMV was detected in BAL with CMV PCR in 145 episodes, and 34 (23%) of these episodes fulfilled the criteria for CMV pneumonia. The AUC-ROC for CMV in BAL was 90% at the optimum cut off (4545 IU/mL) with a corresponding sensitivity of 91% and specificity of 77% (in plasma the corresponding values were 274 IU/mL, 63% and 76%, respectively). Conclusions: CMV PCR viral load in BAL had a high performance to diagnose CMV pneumonia in lung transplant recipients; plasma CMV viral load did not reliably aid as a diagnostic tool. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2xHBeK9
http://ift.tt/2xHBeK9
Sofosbuvir-based Regimens in HIV/HCV Coinfected Patients after Liver Transplantation: Results from the ANRS CO23 CUPILT Study.
Background: A recurrence of hepatitis C virus after liver transplantation affects survival in HIV/HCV coinfected patients. This study assessed the efficacy and safety of sofosbuvir-based regimens in HIV/HCV coinfected patients following liver transplantation. Methods: 29 HIV/HCV coinfected transplanted patients receiving tacrolimus, cyclosporine or everolimus-based immunosuppressive therapy were enrolled in the CUPILT cohort. Their antiviral treatment combined sofosbuvir, daclatasvir with or without ribavirin (n=10/n=6), or sofosbuvir, ledipasvir with or without ribavirin (n=2/n=11). Results: The median delay between liver transplantation and treatment initiation was 37.5 months (IQR 14.4-99.2). The breakdown of HCV genotypes was: G1: 22 patients (75.9%), G3: 3 patients (10.3%) and G4: 4 patients (13.8%). The treatment indications were HCV recurrence (>= F1 n=23) or fibrosing cholestatic hepatitis (n=6). Before starting sofosbuvir, the HCV viral load and CD4 count were 6.7 log10 IU/mL (IQR 5.9-7.2), and 342 cells/mm3 (IQR 172-483), respectively. At W4, the HCV viral load was
http://ift.tt/2xHmo6F
http://ift.tt/2xHmo6F
Swine Leukocyte Antigen (SLA) Class II is a Xenoantigen.
Background: Over 130 000 patients in the United States alone need a life-saving organ transplant. Genetically modified porcine organs could resolve the donor organ shortage, but human xenoreactive antibodies destroy pig cells and are the major barrier to clinical application of xenotransplantation. The objective of this study was to determine whether waitlisted patients possess preformed antibodies to swine leukocyte antigen (SLA) class II, homologs of the class II human leukocyte antigens (HLA). Methods: Sera from people currently awaiting solid organ transplant were tested for IgG binding to class II SLA proteins when expressed on mammalian cells. Pig fibroblasts were made positive by transfection with the class II transactivator (CIITA). As a second expression system, transgenes encoding the alpha and beta chains of class II SLA were transfected into Human embryonic kidney (HEK293) cells. Results: Human sera containing IgG specific for class II HLA molecules exhibited greater binding to class II SLA positive cells than to SLA negative cells. Sera lacking antibodies against class II HLA showed no change in binding regardless of the presence of class II SLA. These antibodies could recognize either SLA-DR or SLA-DQ complexes. Conclusions: Class II SLA proteins may behave as xenoantigens for people with humoral immunity towards class II HLA molecules. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2wNBPh6
http://ift.tt/2wNBPh6
Characteristics of phosphorus components in surface sediments from a Chinese shallow eutrophic lake (Lake Taihu): new insights from chemical extraction and 31 P NMR spectroscopy
Abstract
As a primary factor responsible for lake eutrophication, a deeper understanding of the phosphorus (P) composition and its turnover in sediment is urgently needed. In this study, P species in surface sediments from a Chinese large eutrophic lake (Lake Taihu) were characterized by traditional fractionation and 31P nuclear magnetic resonance (NMR) spectroscopy, and their contributions to the overlying water were also discussed. Fractionation results show that NaOH-P predominated in the algal-dominated zone, accounting for 60.1% to total P in Zhushan Bay. Whereas, refractory fractions including HCl-P and residual-P were the main P burial phases in the macrophyte-dominated zone, the center and lakeshore. Recovery rates of the total P and organic P were greatly improved by using a modified single-step extraction of NaOH-EDTA, ranging from 22.6 to 66.1% and from 15.0 to 54.0%. Ortho-P, monoester-P, and pyro-P are identified as the major P components in the NaOH-EDTA extracts by 31P NMR analysis. Trace amount of DNA-P appeared only in sediments from algal- and macrophyte-dominated zones, ascribing to its biological origin. The relative content of ortho-P is the highest in the algal-dominated zone, while the biogenic P including ester-P and pyro-P is the highest in the macrophyte-dominated zone. Moreover, ortho-P and pyro-P correlated positively with TP and chlorophyll a in the overlying water, whereas only significant relationships were found between monoester-P, biogenic P, and chlorophyll a. These discrepancies imply that inorganic P, mainly ortho-P, plays a vital role in sustaining the trophic level of water body and algal bloom, while biogenic P makes a minor contribution to phytoplankton growth. This conclusion was supported by the results of high proportion of biogenic P in algae, aquatic macrophytes, and suspended particulate from the published literature. This study has significant implication for better understanding of the biogeochemical cycling of endogenous P and its role in affecting lake eutrophication.
http://ift.tt/2vyNdZO
Thyroid Function in Aging: A Discerning Approach
Rejuvenation Research , Vol. 0, No. 0.
http://ift.tt/2vDG5e2
Natural Substances for Prevention of Skin Photoaging: Screening Systems in the Development of Sunscreen and Rejuvenation Cosmetics
Rejuvenation Research , Vol. 0, No. 0.
http://ift.tt/2vlW2uf
Cardiovascular Risk Following Fertility Therapy: Systematic Review and Meta-Analysis
AbstractBackground
The longer term cardiovascular effects of fertility therapy are unknown.
ObjectivesThe aim of this study was to summarize data linking fertility therapy with subsequent cardiovascular outcomes.
MethodsWe systematically searched published reports for studies addressing the question "does fertility therapy increase the risk of longer term cardiovascular outcomes?" We included: 1) human studies; 2) case control, cohort, or randomized designs with 3) exposure to fertility therapy and 4) cardiovascular outcomes clearly reported; 5) presence of comparison group; 6) minimum 1-year follow-up; and 7) adjustment for age. Two independent reviewers screened abstracts, titles, and full texts, and assessed study quality. We used the DerSimonian and Laird random-effects models to pool hazard ratios (HRs) with 95% confidence intervals (CIs) of the following outcomes: acute cardiac event; stroke; venous thromboembolism; hypertension; and diabetes mellitus, comparing women who received fertility therapy with those who did not.
ResultsSix observational studies met inclusion criteria including 41,910 women who received fertility therapy and 1,400,202 women who did not. There was no increased risk of a cardiac event (pooled HR: 0.91; 95% CI: 0.67 to 1.25; I2 = 36.6%), or diabetes mellitus (pooled HR: 0.93; 95% CI: 0.87 to 1.001; I2 = 0%). Results were not pooled for hypertension (I2 = 95.0%) and venous thromboembolism (I2 = 82.3%). There was a trend toward higher risk of stroke (pooled HR: 1.25; 95% CI: 0.96 to 1.63; I2 = 0%).
ConclusionsThe small number of studies and significant heterogeneity precludes definitive reassurance about the longer term cardiovascular safety of these treatments, particularly stroke. Future studies are needed to address ongoing knowledge gaps in this area.
http://ift.tt/2wN6g76
How Medicine Has Changed the End of Life for Patients With Cardiovascular Disease
Abstract
Advances in medicine have changed how patients experience the end of life. With longer life spans, there has also been an increase in years lived with disability. The clustering of illnesses in the last years of life is particularly pronounced in patients with cardiovascular disease. At the end of life, patients with cardiovascular disease are more symptomatic, less likely to die at home, and less likely to receive high-quality palliative care. Social determinants have created widening disparities in end-of-life care. The increasing complexity and duration of care have resulted in an epidemic of caregiver burden. Modern medical care has also resulted in new ethical challenges, for example, those related to deactivation of cardiac devices, such as pacemakers, defibrillators, and mechanical circulatory support. Recommendations to improve end-of-life care for patients with cardiovascular disease include optimizing metrics to assess quality, ameliorating disparities, enhancing education and research in palliative care, overcoming disparities, and innovating palliative care delivery and reimbursement.
http://ift.tt/2wNe20G
Outcomes of Cardiac Resynchronization Therapy With or Without Defibrillation in Patients With Nonischemic Cardiomyopathy
AbstractBackground
Recent studies have cast doubt on the benefit of cardiac resynchronization therapy (CRT) with defibrillation (CRT-D) versus pacing (CRT-P) for patients with nonischemic cardiomyopathy (NICM). Left ventricular myocardial scar portends poor clinical outcomes.
ObjectivesThe aim of this study was to determine whether CRT-D is superior to CRT-P in patients with NICM either with (+) or without (–) left ventricular midwall fibrosis (MWF), detected by cardiac magnetic resonance.
MethodsClinical events were quantified in patients with NICM who were +MWF (n = 68) or –MWF (n = 184) who underwent cardiac magnetic resonance prior to CRT device implantation.
ResultsIn the total study population, +MWF emerged as an independent predictor of total mortality (adjusted hazard ratio [aHR]: 2.31; 95% confidence interval [CI]: 1.45 to 3.68), total mortality or heart failure hospitalization (aHR: 2.02; 95% CI: 1.32 to 3.09), total mortality or hospitalization for major adverse cardiac events (aHR: 2.02; 95% CI: 1.32 to 3.07), death from pump failure (aHR: 1.95; 95% CI: 1.11 to 3.41), and sudden cardiac death (aHR: 3.75; 95% CI: 1.26 to 11.2) over a maximum follow-up period of 14 years (median 3.8 years [interquartile range: 2.0 to 6.1 years] for +MWF and 4.6 years [interquartile range: 2.4 to 8.3 years] for –MWF). In separate analyses of +MWF and –MWF, total mortality (aHR: 0.23; 95% CI: 0.07 to 0.75), total mortality or heart failure hospitalization (aHR: 0.32; 95% CI: 0.12 to 0.82), and total mortality or hospitalization for major adverse cardiac events (aHR: 0.30; 95% CI: 0.12 to 0.78) were lower after CRT-D than after CRT-P in +MWF but not in –MWF.
ConclusionsIn patients with NICM, CRT-D was superior to CRT-P in +MWF but not –MWF. These findings have implications for the choice of device therapy in patients with NICM.
http://ift.tt/2wMZzBZ
Effect of Losartan on Mitral Valve Changes After Myocardial Infarction
AbstractBackground
After myocardial infarction (MI), mitral valve (MV) tethering stimulates adaptive leaflet growth, but counterproductive leaflet thickening and fibrosis augment mitral regurgitation (MR), doubling heart failure and mortality. MV fibrosis post-MI is associated with excessive endothelial-to-mesenchymal transition (EMT), driven by transforming growth factor (TGF)-β overexpression. In vitro, losartan-mediated TGF-β inhibition reduces EMT of MV endothelial cells.
ObjectivesThis study tested the hypothesis that profibrotic MV changes post-MI are therapeutically accessible, specifically by losartan-mediated TGF-β inhibition.
MethodsThe study assessed 17 sheep, including 6 sham-operated control animals and 11 with apical MI and papillary muscle retraction short of producing MR; 6 of the 11 were treated with daily losartan, and 5 were untreated, with flexible epicardial mesh comparably limiting left ventricular (LV) remodeling. LV volumes, tethering, and MV area were quantified by using three-dimensional echocardiography at baseline and at 60 ± 6 days, and excised leaflets were analyzed by histopathology and flow cytometry.
ResultsPost-MI LV dilation and tethering were comparable in the losartan-treated and untreated LV constraint sheep. Telemetered sensors (n = 6) showed no significant losartan-induced changes in arterial pressure. Losartan strongly reduced leaflet thickness (0.9 ± 0.2 mm vs. 1.6 ± 0.2 mm; p < 0.05; 0.4 ± 0.1 mm sham animals), TGF-β, and downstream phosphorylated extracellular-signal–regulated kinase and EMT (27.2 ± 12.0% vs. 51.6 ± 11.7% α-smooth muscle actin–positive endothelial cells, p < 0.05; 7.2 ± 3.5% sham animals), cellular proliferation, collagen deposition, endothelial cell activation (vascular cell adhesion molecule-1 expression), neovascularization, and cells positive for cluster of differentiation (CD) 45, a hematopoietic marker associated with post-MI valve fibrosis. Leaflet area increased comparably (17%) in constrained and losartan-treated sheep.
ConclusionsProfibrotic changes of tethered MV leaflets post-MI can be modulated by losartan without eliminating adaptive growth. Understanding the cellular and molecular mechanisms could provide new opportunities to reduce ischemic MR.
http://ift.tt/2wNeRqe
Optimizing Cholesterol Treatment in Patients With Muscle Complaints
Abstract
Statins are highly effective for preventing cardiovascular events by reducing low-density lipoprotein cholesterol (LDL-C). However, many patients taking statins report muscle-related symptoms that prevent the use of guideline recommended doses. Patients with reported intolerance to statins have a high risk of cardiovascular events. Clinical strategies that optimize cardiovascular risk reduction through LDL-C lowering need to be applied in patients experiencing intolerable side effects that they attribute to statins. In this paper, the authors review definitions of statin intolerance, propose algorithms to better define statin intolerance, and describe approaches to optimize cardiovascular risk reduction among individuals reporting statin-associated muscle symptoms.
http://ift.tt/2xGSuPF
Outcomes After Transplantation of Donor Hearts With Improving Left Ventricular Systolic Dysfunction
AbstractBackground
Left ventricular systolic dysfunction (LVSD) accounts for almost 25% of nonacceptance of potential donor hearts. Previous smaller, single-center studies showed that LVSD following brain death may be transient, and such hearts can be successfully resuscitated with resolution of LVSD, then transplanted.
ObjectivesThis study evaluated outcomes of donor hearts with LVSD on initial transthoracic echocardiogram (TTE) that resolved during donor management.
MethodsWe reviewed echocardiograms of all cardiac donors in the United Network of Organ Sharing database that were transplanted from January 1, 2007, to September 30, 2015, and identified 472 donor hearts with LVSD (left ventricular ejection fraction [LVEF] ≤40%) on initial TTE that resolved (LVEF ≥50%) during donor management on a subsequent TTE. These patients comprised the improved donor LVEF group. These were compared with donor hearts with normal LVEF (LVEF ≥55%) on the initial TTE for recipient mortality, cardiac allograft vasculopathy (CAV), and primary graft failure (PGF).
ResultsThere was no significant difference in recipient mortality at 30 days, 1 year, 3 years, and 5 years of follow-up, nor any difference in rates of PGF at 90 days and CAV at 5 years between recipients of donor hearts with improved LVEF and recipients of donor hearts with initially normal LVEF. Post-transplant length of stay was also similar between the 2 groups. Using propensity scores, 461 transplants in the improved-donor LVEF group were matched to 461 transplants in the normal-donor LVEF group. There was no significant difference in PGF at 90 days or recipient mortality after up to 5 years of follow-up.
ConclusionsIn the largest analysis of donor hearts with transient LVSD, we found that such hearts can be successfully resuscitated and transplanted without increasing recipient mortality, CAV, or PGF. These results underscore the importance of appropriate donor management and should help to increase utilization of donor hearts with transient LVSD.
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Ivabradine in Children With Dilated Cardiomyopathy and Symptomatic Chronic Heart Failure
AbstractBackground
Heart rate reduction as a therapeutic target has been investigated in adults with heart failure (HF). Ivabradine has shown promising efficacy, but has not been evaluated in children. Currently, treatment recommendations for chronic pediatric HF are based mainly on chronic HF guidelines for adults.
ObjectivesThe authors explored the dose-response relationship of ivabradine in children with dilated cardiomyopathy and symptomatic chronic HF. The primary endpoint was ≥20% reduction in heart rate from baseline without inducing bradycardia or symptoms.
MethodsThis was a randomized, double-blind, placebo-controlled, phase II/III study with 12 months of follow-up. Children (n = 116) receiving stable HF therapy were randomized to either ivabradine or placebo. After an initial titration period, the dose was adjusted to attain the primary endpoint. Left ventricular function (echocardiography), clinical status (New York Heart Association functional class or Ross class), N-terminal pro–B-type natriuretic peptide, and quality of life (QOL) were assessed.
ResultsThe primary endpoint was reached by 51 of 73 children taking ivabradine (70%) versus 5 of 41 taking placebo (12%) at varying doses (odds ratio: 17.24; p < 0.0001). Between baseline and 12 months, there was a greater increase in left ventricular ejection fraction in patients taking ivabradine than placebo (13.5% vs. 6.9%; p = 0.024). New York Heart Association functional class or Ross class improved more with ivabradine at 12 months than placebo (38% vs. 25%; p = 0.24). There was a trend toward improvement in QOL for ivabradine versus placebo (p = 0.053). N-terminal pro–B-type natriuretic peptide levels decreased similarly in both groups. Adverse events were reported at similar frequencies for ivabradine and placebo.
ConclusionsIvabradine safely reduced the resting heart rate of children with chronic HF and dilated cardiomyopathy. Ivabradine's effect on heart rate was variable, highlighting the importance of dose titration. Ivabradine treatment improved left ventricular ejection fraction, and clinical status and QOL showed favorable trends. (Determination of the efficacious and safe dose of ivabradine in paediatric patients with dilated cardiomyopathy and symptomatic chronic heart failure from ages 6 months to 18 years; ISRCTN60567801)
http://ift.tt/2wN6zPq
Granulomatous skin reactions after tumor vaccine in two patients
Abstract
Two patients with HNPCC-syndrome (Hereditary Non-Polyposis Colorectal Cancer), an autosomal dominant genetic disorder in which patients are at higher risk of developing colorectal cancer, presented in our out-patient clinic with asymptomatic skin alterations at the injection sites of an experimental tumor-specific vaccine. The vaccine was given as part of a study in which colorectal carcinoma patients with lymph node and organ metastases and high microsatellite instability (MSI-H) received a vaccine containing fragments of specific tumor proteins. Both patients, a 60-year-old and 54-year-old male, had noted multiple slow-growing, firm, indolent erythematous to violaceous nodes of up to 4 cm in diameter on both upper arms at former injection sites approximately one year after receiving the tumor-specific vaccination (figure 1).
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The usefulness of investigating the possible underlying conditions in rosacea
Abstract
The paper entitled "Rosacea and demodicidosis with gain of function mutation in STAT1″ by Second et al.1 is of indubitable interest and prompted us to make some observations. The Authors described a patient with cutaneous and ocular rosacea that they related to demodicidosis since oral ivermectin improved the cutaneous lesions1. However, the Authors did not demonstrate by skin scraping nor by standardized skin surface biopsy (SSSB) an excessive number of Demodex folliculorum (DF) mites in the pilosebaceous units to justify an oral antiparasitic treatment as a drug of first choice1.
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Prevalence of age-related macular degeneration in rural southern China: the Yangxi Eye Study
Purpose
To describe the prevalence of age-related macular degeneration (AMD) among older adults in rural southern mainland China.
MethodsEligible persons aged 50 years or over were identified by geographically defined cluster sampling from Yangxi County, Guangdong Province, China. Participants underwent a standardised interview and comprehensive eye examinations from August to November in 2014. Digital retinal photographs were graded for AMD lesions using the Clinical Classification of Age-Related Macular Degeneration developed by the Beckman Initiative for Macular Research Classification Committee. Age-standardised prevalence of AMD and AMD lesions was calculated using the 2010 world population data and compared with those of other populations.
ResultsOf 5825 subjects who participated (90.7% response rate), 4881 (83.8%) had fundus photographs gradable for AMD. Early, intermediate and late AMD were present in 2003 (41.0%), 879 (18.0%) and 42 (0.86%) participants. The age-standardised prevalence of early, intermediate and late AMD was 40.4% (95% CI 39.6% to 41.2%), 17.6% (95% CI 17.0% to 18.2%) and 0.79% (95% CI 0.65% to 0.95%), respectively. Total AMD was more prevalent in men than in women (62.8% vs 57.1%).
ConclusionsAMD is an important public health concern for rural southern China, and the prevalence of AMD was higher in men than in women.
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Bullous X linked retinoschisis: clinical features and prognosis
Background/Aims
A subset of patients with X linked retinoschisis (XLRS) have bullous schisis cavities in the peripheral retina. This study describes the characteristics and prognosis of the bullous form of XLRS.
MethodsA retrospective case series was performed of nine patients with molecularly proven bullous XLRS seen at a single tertiary centre.
ResultsAll cases of bullous peripheral schisis were bilateral, with one unilateral case at presentation which developed into bilateral bullous schisis over time. The mean age of onset was 1.9 years (range: 1 month–7 years, SD: 2.1 years) and at clinical diagnosis was 5.9 years (range: 1 month–27 years, SD: 9.0 years). Mean follow-up was 11 years (range: 6 months–36 years, SD: 10.8 years). Strabismus was the most common presentation (n=7). Other presenting complaints included decreased vision, floaters and an irregularly shaped pupil. The most frequently associated ocular features were strabismus (100%), vitreous haemorrhage (4/18 eyes, 22%), nystagmus (2/9, 22%) and persistent fetal vasculature (1/18, 6%). Localised tractional detachment was seen in 2/18 (11%) eyes, total detachment that underwent surgical repair in 1/18 (6%) and pigmented demarcation lines in a further 22% of the eyes. There was one eye with exudative retinal detachment.
ConclusionIn XLRS, bullous schisis may be congenital or develop soon after birth and most commonly presents with strabismus. Cases may be complicated by some form of retinal detachment, which may be tractional or a Coats-like exudative detachment.
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Prevalence of amblyopia and its association with refraction in Chinese preschool children aged 36-48 months
Purpose
To determine the prevalence of amblyopia and its association with refraction in Chinese preschool children.
MethodsThe Yuhuatai Pediatric Eye Disease Study, a cross-sectional, population-based study, was conducted in children aged 36–48 months in Yuhuatai District, Nanjing, China, in 2015. Visual acuity was measured in 1695 eligible children.
ResultsOf the 1695 subjects, manifested amblyopia was detected in 25 children (1.47%, 95% CI 0.90% to 2.05%), including 11 and 14 with bilateral and unilateral amblyopia, respectively. Amblyopia prevalence did not differ by gender (p=0.77). Significant refractive errors were found in 22 (88.0%) of children with amblyopia, and strabismus was found in 6 (24.0%) children with amblyopia. In multivariate analysis, amblyopia was significantly associated with hyperopia (≥+2.00 dioptres (D); OR 8.81, 95% CI 3.27 to 23.69, p<0.0001), astigmatism (≥2.00 D; OR 17.90, 95% CI 6.78 to 47.21, p<0.0001) and anisometropia (≥2.00 D; OR 5.87, 95% CI 1.52 to 22.77, p<0.05).
ConclusionsThe prevalence of amblyopia in children 36–48 months old in Eastern China was 1.47%. The refractive error is a major risk factor for amblyopia.
http://ift.tt/2wXdyV1
Cutaneous sporotrichosis treated with methylene blue-daylight photodynamic therapy
Abstract
Sporotrichosis is an infection caused by the dimorphic fungus,Sporothrix schenckii. Acquisition typically occurs via cutaneous inoculation with development of a localized cutaneous and/or lymphocutaneous infection. aPDT (antimicrobial photodynamic therapy) is a process that generates reactive oxygen species (ROS) in presence of a photosensitizer, visible light and oxygen which destroys fungal and bacterial cells(1). Daylight PDT (DL-PDT) uses the visible spectrum of daylight (400-750nm) for the activation of the photosensitizer instead of an artificial light source. It is currently approved to treat actinic keratosis(2). The band of absorption of MB is between 550-700nm, with an absorption peak of 654nm.
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Immune deficiency and rosacea
Abstract
They wonder whether the patients that we reported definitely had demodicidosis associated to rosacea, and above all provide, they their own interesting findings in 60 patients with rosacea, findings that we will not comment here.We agree that skin scraping with a D. folliculorum count is certainly the less unreliable way to support a diagnosis of demodicidosis. We did not perform this test, since in our experience, strong itching in papulo-pustular rosacea in individuals with immune deficiency is always associated with D. folliculorum proliferation.
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Chronic Urticaria and the Metabolic Syndrome: a Cross-sectional Community-based Study of 11,261 Patients
Abstract
Background
Emerging evidence suggests that chronic urticaria (CU) is associated with chronic, low grade, inflammatory process.
Objective
To evaluate the association between CU and metabolic syndrome and its components in a large community-based medical database.
Methods
A cross-sectional study of CU patients and matched controls was performed. CU was defined as eight urticaria diagnoses (with each two diagnoses registered within a period of six weeks) from 2002 to 2012. Data regarding the prevalence of metabolic syndrome, its components, and possible complications were collected.
Results
The study included 11,261 patients with CU and 67,216 controls. In a univariate analysis, CU was significantly associated with higher body mass index (BMI) and a higher prevalence of obesity, diabetes, hyperlipidemia, hypertension, metabolic syndrome, chronic renal failure, and gout. Multivariate analysis demonstrated a significant association between CU and metabolic syndrome (OR = 1.12, 95% CI 1.1-1.2, p < 0.001) and its components- obesity (OR = 1.2, 95% CI 1.1-1.3, p < 0.001), diabetes (OR = 1.08, 95% CI 1.01-1.15, p = 0.001), hyperlipidemia (OR = 1.2, 95% CI 1.1-1.2, p < 0.001), and hypertension (OR = 1.1, 95% CI 1.1-1.2, p < 0.001).
Conclusions
CU patients may have one or more undiagnosed components of metabolic syndrome despite their young age. Thus, appropriate targeted screening is advised.
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Long-Term Efficacy and Safety of Sonidegib in Patients With Locally Advanced and Metastatic Basal Cell Carcinoma: 30-Month Analysis of the Randomized Phase 2 BOLT Study
Abstract
Background
Patients with locally advanced basal cell carcinoma (laBCC) or metastatic BCC (mBCC), 2 difficult-to-treat populations, have had limited treatment options. Sonidegib, a hedgehog pathway inhibitor (HPI), was approved in laBCC based on results from the BOLT trial.
Objective
To evaluate long-term efficacy and safety of sonidegib in laBCC and mBCC in the BOLT 18- and 30-month analyses.
Methods
BOLT (NCT01327053, ClinicalTrials. gov), a double-blind phase 2 study, enrolled patients from July 2011 until January 2013. Eligible HPI-treatment naïve patients with laBCC not amenable to curative surgery/radiotherapy or mBCC were randomized 1:2 to sonidegib 200 mg (laBCC, n = 66; mBCC, n = 13) or 800 mg (laBCC, n = 128; mBCC, n = 23). Tumor response was assessed per central and investigator review.
Results
With 30 months of follow-up, among patients treated with sonidegib 200 mg (approved dose), objective response rates were 56.1% (central) and 71.2% (investigator) in laBCC and 7.7% (central) and 23.1% (investigator) in mBCC. Tumor responses were durable: median duration of response was 26.1 months (central) and 15.7 months (investigator) in laBCC and 24.0 months (central) and 18.1 months (investigator) in mBCC. Five patients with laBCC and 3 with mBCC in the 200-mg arm died. Median overall survival was not reached in either population; 2-year overall survival rates were 93.2% (laBCC) and 69.3% (mBCC). In laBCC, efficacy was similar regardless of aggressive or nonaggressive histology. Sonidegib 200 mg continued to have a better safety profile than 800 mg, with lower rates of grade 3/4 adverse events (43.0% vs 64.0%) and adverse events leading to discontinuation (30.4% vs 40.0%).
Conclusion
Sonidegib continued to demonstrate long-term efficacy and safety in these populations. These data support the use of sonidegib 200 mg per local treatment guidelines.
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Different Expression Patterns of Plasma Th1-, Th2-, Th17-, and Th22-Related Cytokines Correlate with Serum Autoreactivity and Allergen Sensitivity in Chronic Spontaneous Urticaria
Abstract
Background
Clinical features and basophil activation levels correlate with serum autoreactivity and allergen sensitivity in patients with chronic spontaneous urticaria (CSU).
Objectives
To explore the relationship of the expression patterns of plasma T-helper cell (Th) 1, Th2, Th17, and Th22-related cytokines with the serum autoreactivity and the allergen sensitivity in CSU.
Method
Twenty related cytokines were measured and analysed in 60 CSU patients, 15 acute urticaria patients, 10 patients with atopic dermatitis (AD), and 15 healthy persons, respectively. Autologous serum skin testing (ASST) and skin prick testing (SPT) were performed to detect autoreactivity and allergy sensitivity, respectively. The protein-protein interaction of cytokines and the molecular pathways were analysed by Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) and KyotoEncyclopedia of Genes and Genomes (KEGG database), respectively.
Results
Th1/Th2 and Th17 related cytokines were significantly elevated and correlated with disease activity in CSU than in healthy controls. Interleukin (IL)-6, IL-10, and IL-13 were significantly higher in acute urticaria than in CSU patients. Granulocyte/macrophage colony-stimulating factor (GM-CSF), IL-10 and IL-17 were significantly higher in ASST + than in ASST- CSU patients. IFN-γ, IL-2, IL-12p70, and IL-21 were significantly higher in SPT + than in SPT- CSU patients. The plasma levels of interferon-γ, IL-2, and IL-21 varied among ASST+/SPT+, ASST+/SPT-, ASST-/SPT+, and ASST-/SPT- CSU subgroups, which appeared to involve the positive regulation of the Janus kinase-signal transducer and activator of transcription (Jak-STAT) signaling pathway.
Conclusion
This study indicates acute urticaria elicits a more prominent Th2 immune response than CSU. There was association between different expression patterns of plasma Th1-, Th2-, Th17-, and Th22-related cytokines and serum autoreactivity or allergen sensitivity in CSU. Further studies on the JAK-STAT pathway in the pathogenesis of CSU is warranted.
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Dermoscopy and the diagnosis of primary cutaneous B-cell lymphoma
Abstract
Background
Primary cutaneous B-cell lymphomas (PCBCL) are frequently misdiagnosed and a biopsy is needed to attain the correct diagnosis.
Objective
To characterize the dermoscopic features of PCBCL.
Methods
In this retrospective observational study we analyzed the pathology reports of 172 newly diagnosed PCBCL for the initial clinical differential diagnosis. The dermoscopic images of 58 PCBCL were evaluated for dermoscopic features. Two dermoscopy experts, who were blinded to the diagnosis and the study objective, evaluated images from 17 cases for a dermoscopic differential diagnosis.
Results
Of 172 biopsy-proven PCBCL lesions, cutaneous lymphoma was suspected by the clinician in 16.3%; the leading diagnosis was basal cell carcinoma in 17.4%, and other skin neoplasms in 21%. Studying 58 PCBCL dermoscopic images, we most frequently identified salmon-colored background/area (79.3%) and prominent blood vessels (77.6%), mostly of serpentine (linear-irregular) morphology (67.2%). Dermoscopic features did not differ significantly by subtype or location. Blinded evaluation by dermoscopy experts raised a wide differential diagnosis including PCBCL, arthropod bite, basal cell carcinoma, amelanotic melanoma and scar/keloid.
Conclusions
Two dermoscopic features, salmon-colored area/background and serpentine vessels, are frequently seen in PCBCL lesions. These characteristic dermoscopic features, although not specific, can suggest a possible diagnosis of PCBCL.
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Dermoscope-guided lesional biopsy to diagnose EMA+ CK7+ CK20+ extramammary Paget's disease with an extensive lesion
Abstract
Dermoscopy has been reported to facilitate the diagnosis of extramammary Paget's disease (EMPD).1-3 We report here the first application of dermoscope-guided lesional biopsy to confirm the diagnosis of EMPD. A 60-year-old male presented with a pruritic and painful rash over his left groin region for six months.
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Obstetric Outcomes in Women with Nonalcoholic Fatty Liver Disease
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2wc4b3c
Correction: Cerebral venous sinus thrombosis during superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for maxillary squamous cell carcinoma
Okamura S, Saito Y, Mori H, Yamasoba T. Cerebral venous sinus thrombosis during superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for maxillary squamous cell carcinoma. BMJ Case Rep. Published Online First: 12 May 2017. doi:10.1136/bcr-2017-220591
The line '(1) the indwelling catheter in;' should read:
(1) the indwelling catheter in the common carotid artery decreased brain venous flow;
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Correction: Vitamin A deficiency due to chronic malabsorption: an ophthalmic manifestation of a systemic condition
Cheshire J, Kolli S. Vitamin A deficiency due to chronic malabsorption: an ophthalmic manifestation of a systemic condition. BMJ Case Rep. Published Online First: 10 May 2017. doi:10.1136/bcr-2017-220024
In this article, the author affiliations are incorrect; the correct affiliations are listed below.
James Cheshire: Heart of England NHS Foundation Trust, Birmingham, UK
Sai Kolli: Department of Ophthalmology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
http://ift.tt/2gjAlnD
A Rare, Unforeseen Complication Of Facial Skin Resurfacing
Erosive pustular dermatitis (EPD), a rare condition that typically affects actinically damaged skin on the scalp, may also emerge on the face after cosmetic resurfacing, researchers have found.
Reuters Health Information
http://ift.tt/2gd80zm
Age-related histologic and biochemical changes in auricular and septal cartilage
Objectives/Hypothesis
To characterize the histologic and biochemical properties of auricular and septal cartilage and analyze age-related changes in middle-aged to older adults.
Study Design
Cross-sectional study of auricular and septal cartilage from 33 fresh cadavers.
Methods
Auricular and septal cartilage specimens were stained using Safranin O for glycosaminoglycans, Verhoeff's stain for elastin, and Masson's trichrome for collagen. Percentage of tissue stained, cell density and size were quantified. Relationships between donor characteristics and histologic properties were evaluated using mixed model analyses.
Results
The average donor age was 75 years (standard deviation = 11 years; range, 55–93 years). In auricular cartilage, each 1-year increase in age was associated with a 0.97% decrease in glycosaminoglycans (P < .001) and a 0.98% decrease in elastin (P < .001). In septal cartilage, glycosaminoglycans decreased 2.4% per year (P < .001). Age did not affect collagen content significantly in auricular (P = .417) or septal cartilage (P = .284). Cell density and cell size declined with age in auricular (both P < .001) and septal cartilage (P = .044, P = .032, respectively). Compared to septal cartilage in patients of all ages, auricular cartilage had more glycosaminoglycans, less collagen, higher cell density, and smaller cells.
Conclusions
In auricular and septal cartilage, glycosaminoglycans, elastin, cell density, and cell size decrease significantly with age in patients over 55 years of age. Glycosaminoglycan content declines faster with age in septal cartilage than auricular cartilage. These age-related changes may affect biomechanical properties and tissue viability, and thereby have implications for graft choice in functional, aesthetic, and reconstructive nasal surgery.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2iBX1Ai
Age-related histologic and biochemical changes in auricular and septal cartilage
Objectives/Hypothesis
To characterize the histologic and biochemical properties of auricular and septal cartilage and analyze age-related changes in middle-aged to older adults.
Study Design
Cross-sectional study of auricular and septal cartilage from 33 fresh cadavers.
Methods
Auricular and septal cartilage specimens were stained using Safranin O for glycosaminoglycans, Verhoeff's stain for elastin, and Masson's trichrome for collagen. Percentage of tissue stained, cell density and size were quantified. Relationships between donor characteristics and histologic properties were evaluated using mixed model analyses.
Results
The average donor age was 75 years (standard deviation = 11 years; range, 55–93 years). In auricular cartilage, each 1-year increase in age was associated with a 0.97% decrease in glycosaminoglycans (P < .001) and a 0.98% decrease in elastin (P < .001). In septal cartilage, glycosaminoglycans decreased 2.4% per year (P < .001). Age did not affect collagen content significantly in auricular (P = .417) or septal cartilage (P = .284). Cell density and cell size declined with age in auricular (both P < .001) and septal cartilage (P = .044, P = .032, respectively). Compared to septal cartilage in patients of all ages, auricular cartilage had more glycosaminoglycans, less collagen, higher cell density, and smaller cells.
Conclusions
In auricular and septal cartilage, glycosaminoglycans, elastin, cell density, and cell size decrease significantly with age in patients over 55 years of age. Glycosaminoglycan content declines faster with age in septal cartilage than auricular cartilage. These age-related changes may affect biomechanical properties and tissue viability, and thereby have implications for graft choice in functional, aesthetic, and reconstructive nasal surgery.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2iBX1Ai
Combined surgical and endovascular approach to treat a carotid cavernous fistula with associated brainstem venous congestion
Endovascular embolization is the standard approach for management of carotid cavernous fistulas (CCFs) due to the ease of access and reduced level of risk associated with the procedure compared with open surgery. We present here a case of a CCF that eventually led to the development of brainstem venous congestion from perimedullary venous drainage. This fistula was not amenable to endovascular embolization due to lack of either ophthalmic vein or petrosal sinus drainage. Therefore, a craniotomy with direct puncture of the cavernous sinus was performed, followed by coil embolization to completely treat this fistula. This case demonstrates an uncommon progression of venous drainage to Cognard grade V, rare development of symptomatic brainstem venous congestion and a unique method to combine an open surgical approach with endovascular embolization to treat CCFs.
http://ift.tt/2xr3D8j
Nrf2-peroxiredoxin I axis in polymorphous adenocarcinoma is associated with low matrix metalloproteinase 2 level
Abstract
Polymorphous adenocarcinoma (PAC) is a malignant epithelial neoplasm that affects almost exclusively the minor salivary glands, generally described as having a relatively good prognosis. Aberrant nuclear factor erythroid 2 (NF-E2)-related factor (Nrf2) activation in tumor cells has been associated with induction of antioxidant enzymes, such as peroxiredoxin I (Prx I) and increased matrix metalloproteinase (MMP) expression. In this context, the aim of the present study was to evaluate the expression of Nrf2 and correlate it with Prx I and MMP-2 secretion in PAC. Thirty-one cases of PAC from oral biopsies were selected and immunohistochemically analyzed for Nrf2 and Prx I. MMP-2 quantification was performed on primary cell cultures derived from PAC. Oral squamous cell carcinoma (OSCC) cell cultures were used as control. A high immunoexpression of Nrf2 was observed in both the cytoplasm and the nucleus of neoplastic cells from PAC. Nuclear staining for Nrf2 suggested its activation in the majority of the PAC cells, which was confirmed by the high expression of its target gene, Prx I. Quantification of MMP-2 secretion showed lower levels in PAC cell cultures when compared to OSCC cell cultures (p < 0.05). In conclusion, although Nrf2 overexpression has been frequently associated with high-grade malignancies, such relationship is not infallible and, in fact, the opposite may occur in low-grade tumors, such as PAC of minor salivary glands.
http://ift.tt/2xr8OF2
A retrospective study of amrubicin monotherapy for the treatment of relapsed small cell lung cancer in elderly patients
Abstract
Purpose
Amrubicin is one of the most active chemotherapeutic drugs for small cell lung cancer (SCLC). Previous studies reported its effectiveness and severe hematological toxicity. However, the efficacy of amrubicin monotherapy in elderly patients with SCLC has not been described. The objective of this study was to investigate the feasibility of amrubicin monotherapy in elderly patients and its efficacy for relapsed SCLC.
Methods
A retrospective cohort study design was used. We retrospectively evaluated the clinical effects and adverse events of amrubicin treatment in elderly (≥70 years) SCLC patients with relapsed SCLC.
Results
Between November 2003 and September 2015, 86 patients (aged ≥70 years) received amrubicin monotherapy for relapsed SCLC at four institutions. There were 42 cases of sensitive relapse (S) and 44 of refractory relapse (R). S cases with median age of 75 years (range 70–85 years) and R cases with median age of 74 years (range 70–84 years) were included in our analysis. The median number of treatment cycles was three (range 1–9), and the response rate was 33.7% (40.5% in the S and 27.2% in the R cases). Median progression-free survival time was 4.0 months in the S and 2.7 months in the R patients (p = 0.013). Median survival time from the start of amrubicin therapy was 7.6 months in the S and 5.5 months in the R cases (p = 0.26). The frequencies of grade ≥3 hematological toxicities were as follows: leukopenia, 60.4%; neutropenia, 74.4%; anemia, 11.6%; thrombocytopenia, 16.2%; and febrile neutropenia, 17.4%. Treatment-related death was observed in one patient.
Conclusion
Although hematological toxicities, particularly neutropenia, were severe, amrubicin showed favorable efficacy, not only in the S but also in the R cases, as shown in previous studies. Amrubicin could be a preferable standard treatment in elderly patients with relapsed SCLC. These results warrant further evaluation of amrubicin in elderly patients with relapsed SCLC by a prospective trial.
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Survival data for postoperative adjuvant chemotherapy comprising cisplatin plus vinorelbine after complete resection of non-small cell lung cancer
Abstract
Purpose
Despite the efficacy of postoperative adjuvant cisplatin (CDDP)-based chemotherapy for patients who have undergone surgical resection of non-small cell lung cancer (NSCLC), few reports have presented survival data for Asian patients treated with adjuvant chemotherapy involving a combination of CDDP and vinorelbine (VNR). This study was performed to evaluate the survival of patients with NSCLC who received postoperative adjuvant chemotherapy comprising CDDP + VNR.
Methods
We retrospectively evaluated patients with NSCLC who received adjuvant chemotherapy comprising CDDP + VNR at the Shizuoka Cancer Center between February 2006 and October 2011.
Results
One hundred patients who underwent surgical resection of NSCLC were included in this study. The patients' characteristics were as follows: median age 63 years (range 36–74 years), female 34%, never-smokers 20%, and non-squamous NSCLC 73%. Pathological stages IIA, IIB, and IIIA were observed in 31, 22, and 47% of patients, respectively. The 5- and 2-year overall survival rates were 73 and 93%, respectively. The 5- and 2-year relapse-free survival rates were 53 and 62%, respectively. Univariate analysis of prognostic factors showed that patient characteristics (sex, histology, and pathological stage) and CDDP dose intensity were not significantly associated with survival. In 48 patients who developed NSCLC recurrence, the 5-year survival rate after recurrence was 29%, and the median survival time after recurrence was 37 months.
Conclusions
Our results suggest that the prognosis after surgical resection of NSCLC and adjuvant chemotherapy comprising CDDP + VNR might be improving compared with previous survival data of adjuvant chemotherapy for NSCLC.
http://ift.tt/2wCy6T2
sIL-24 peptide, a human interleukin-24 isoform, induces mitochondrial-mediated apoptosis in human cancer cells
Abstract
Purpose
Interleukin-24 (IL-24) is a unique cytokine in the IL-10 family that reveals tumor-suppressive activity against a broad range of cancers. Alternative splicing of human IL-24 generates several isoforms with different pro-apoptotic activities. In the current study, we aimed to investigate the cytotoxic properties of a recombinant smallest isoform of IL-24 (sIL-24) and the underlying molecular mechanisms in PC-3, A549, U937, and Raji cancer cells as well as normal cell line MRC-5.
Methods
Following treatment of the cells with recombinant sIL-24 peptide and full-length IL-24 protein, cytotoxicity was determined by MTT assay. Apoptosis induction was evaluated using annexin-V/PI double staining flow cytometry and Hoechst 33342 staining. The expression of Bax, Bcl-2, cytochrome c, and caspase-3 was analyzed by Western blotting.
Results
MTT assay exhibited that sIL-24 dose and time dependently inhibited the proliferation of IL-24 receptor-positive PC-3, U937, and Raji cells more effectively than full-length IL-24. In contrast, sIL-24 had little cytotoxic effect on A549 cells lacking the IL-24 receptor, or on MRC-5 normal cells. Flow cytometric analysis and morphological observation revealed an efficient apoptosis induction in the receptor-positive cells. Furthermore, Western blot assay demonstrated that cell death induced by sIL-24 was associated with upregulation of the Bax/Bcl-2 ratio, cytochrome c release, and the expression of cleaved caspase-3, suggesting that sIL-24 induced apoptosis mainly through the mitochondrial pathway. Notably, among the tested cells, induction of apoptosis was more significant in PC-3 cells.
Conclusion
Our results suggest that the sIL-24 peptide is a promising candidate for potential treatment of human cancers.
http://ift.tt/2wid09V
Trends in restorative composites research: what is in the future?
Abstract Clinical trials have identified secondary caries and bulk fracture as the main causes for composite restoration failure. As a measure to avoid frequent reinterventions for restoration replacement, composites with some sort of defense mechanism against biofilm formation and demineralization, as well as materials with lower susceptibility to crack propagation are necessary. Also, the restorative procedure with composites are very time-consuming and technically demanding, particularly concerning the application of the adhesive system. Therefore, together with bulk-fill composites, self-adhesive restorative composites could reduce operator error and chairside time. This literature review describes the current stage of development of remineralizing, antibacterial and self-healing composites. Also, an overview of the research on fiber-reinforced composites and self-adhesive composites, both introduced for clinical use in recent years, is presented.
http://ift.tt/2xGtOa2
Should my composite restorations last forever? Why are they failing?
Abstract Composites resins have become the first choice for direct anterior and posterior restorations. The great popularity is related to their esthetic appearance and reduced need of sound tissue removal as compared with former treatments. Several studies have demonstrated that composite restorations may last long in clinical service. In this review we discuss the factors playing a role on the long-term longevity. Composite restorations have demonstrated a good clinical performance with annual failure rates varying from 1% to 3% in posterior teeth and 1% to 5% in anterior teeth. Factors related to the patients such as caries risk and occlusal stress risk, in addition to socioeconomic factors, may affect the survival significantly. Characteristics of the clinical operators, particularly their decision making when it comes to observing or approaching an existing restoration, are decisive for longevity. Cavity features such as the number of restored walls, composite volume, and presence of endodontic treatment are of major importance and may dictate the service time of the restorative approach. The choice of restorative composite seems to have a minor effect on longevity provided that appropriate technical procedures are used. The main reasons for failure in posterior teeth are secondary caries and fracture (restoration or tooth/restoration), while in anterior teeth esthetic concerns are the main reasons leading to restoration failures. Composite resin restorations can be considered a reliable treatment as long as both the professional and the patient are aware of the factors involved in restoration failures.
http://ift.tt/2wMupuq
Bonding efficiency and durability: current possibilities
Abstract Bonding plays a major role in dentistry nowadays. Dental adhesives are used in association with composites to solve many restorative issues. However, the wide variety of bonding agents currently available makes it difficult for clinicians to choose the best alternative in terms of material and technique, especially when different clinical situations are considered. Moreover, although bonding agents allow for a more conservative restorative approach, achieving a durable adhesive interface remains a matter of concern, and this mainly due to degradation of the bonding complex in the challenging oral environment. This review aims to present strategies that are being used or those still in development which may help to prevent degradation. It is fundamental that professionals are aware of these strategies to counteract degradation as much as possible. None of them are efficient to completely solve this problem, but they certainly represent reasonable alternatives to increase the lifetime of adhesive restorations.
http://ift.tt/2xGtZlZ
Dental ceramics: a review of new materials and processing methods
Abstract The evolution of computerized systems for the production of dental restorations associated to the development of novel microstructures for ceramic materials has caused an important change in the clinical workflow for dentists and technicians, as well as in the treatment options offered to patients. New microstructures have also been developed by the industry in order to offer ceramic and composite materials with optimized properties, i.e., good mechanical properties, appropriate wear behavior and acceptable aesthetic characteristics. The objective of this literature review is to discuss the main advantages and disadvantages of the new ceramic systems and processing methods. The manuscript is divided in five parts: I) monolithic zirconia restorations; II) multilayered dental prostheses; III) new glass-ceramics; IV) polymer infiltrated ceramics; and V) novel processing technologies. Dental ceramics and processing technologies have evolved significantly in the past ten years, with most of the evolution being related to new microstructures and CAD-CAM methods. In addition, a trend towards the use of monolithic restorations has changed the way clinicians produce all-ceramic dental prostheses, since the more aesthetic multilayered restorations unfortunately are more prone to chipping or delamination. Composite materials processed via CAD-CAM have become an interesting option, as they have intermediate properties between ceramics and polymers and are more easily milled and polished.
http://ift.tt/2wMmldt
Efficiency of polymerization of bulk-fill composite resins: a systematic review
Abstract This systematic review assessed the literature to evaluate the efficiency of polymerization of bulk-fill composite resins at 4 mm restoration depth. PubMed, Cochrane, Scopus and Web of Science databases were searched with no restrictions on year, publication status, or article's language. Selection criteria included studies that evaluated bulk-fill composite resin when inserted in a minimum thickness of 4 mm, followed by curing according to the manufacturers' instructions; presented sound statistical data; and comparison with a control group and/or a reference measurement of quality of polymerization. The evidence level was evaluated by qualitative scoring system and classified as high-, moderate- and low- evidence level. A total of 534 articles were retrieved in the initial search. After the review process, only 10 full-text articles met the inclusion criteria. Most articles included (80%) were classified as high evidence level. Among several techniques, microhardness was the most frequently method performed by the studies included in this systematic review. Irrespective to the "in vitro" method performed, bulk fill RBCs were partially likely to fulfill the important requirement regarding properly curing in 4 mm of cavity depth measured by depth of cure and / or degree of conversion. In general, low viscosities BFCs performed better regarding polymerization efficiency compared to the high viscosities BFCs.
http://ift.tt/2xGABjY
Randomized clinical trials of dental bleaching – Compliance with the CONSORT Statement: a systematic review
Abstract We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at "low" risk; 62.1% were classified as "unclear"; and 30.3% as "high" risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.
http://ift.tt/2wMsqXg
Light curing in dentistry and clinical implications: a literature review
Abstract Contemporary dentistry literally cannot be performed without use of resin-based restorative materials. With the success of bonding resin materials to tooth structures, an even wider scope of clinical applications has arisen for these lines of products. Understanding of the basic events occurring in any dental polymerization mechanism, regardless of the mode of activating the process, will allow clinicians to both better appreciate the tremendous improvements that have been made over the years, and will also provide valuable information on differences among strategies manufacturers use to optimize product performance, as well as factors under the control of the clinician, whereby they can influence the long-term outcome of their restorative procedures.
http://ift.tt/2wM73Fn
Polymerization shrinkage stress of composite resins and resin cements – What do we need to know?
Abstract Polymerization shrinkage stress of resin-based materials have been related to several unwanted clinical consequences, such as enamel crack propagation, cusp deflection, marginal and internal gaps, and decreased bond strength. Despite the absence of strong evidence relating polymerization shrinkage to secondary caries or fracture of posterior teeth, shrinkage stress has been associated with post-operative sensitivity and marginal stain. The latter is often erroneously used as a criterion for replacement of composite restorations. Therefore, an indirect correlation can emerge between shrinkage stress and the longevity of composite restorations or resin-bonded ceramic restorations. The relationship between shrinkage and stress can be best studied in laboratory experiments and a combination of various methodologies. The objective of this review article is to discuss the concept and consequences of polymerization shrinkage and shrinkage stress of composite resins and resin cements. Literature relating to polymerization shrinkage and shrinkage stress generation, research methodologies, and contributing factors are selected and reviewed. Clinical techniques that could reduce shrinkage stress and new developments on low-shrink dental materials are also discussed.
http://ift.tt/2xGD12a
An Asian Perspective on Povidone Iodine in Wound Healing
Antiseptics, with a broader spectrum of antimicrobial efficacy, lower risk of antibiotic resistance development, and minimal collateral damage to host tissues, are important alternatives to control the bioburden in wounds. Povidone iodine (PVP-I), in use for several decades, has the broadest spectrum of activity, a persistent antimicrobial effect, an ability to penetrate biofilms, and a lack of acquired or cross-resistance. It demonstrates good skin tolerance and low cytotoxicity. However, some reports on PVP-I have raised concerns over allergy, ineffective penetration, and toxic effects on host cells. The majority of these concerns are based on in vitro or rodent wound studies with diverse study designs and outcomes; these results may not be directly applicable in the clinical reality in humans. In this paper, we discuss the efficacy and safety of PVP-I and outline its place in wound healing in Asia, based on an appraisal of recent literature and clinical practice across the region.
Dermatology
http://ift.tt/2vl6CkY
Sex Differences in Pediatric Rheumatology
Abstract
Autoimmune diseases affect up to 10% of the world's population and, as a whole, they are far more common in females, although differences exist according to the single disease and also in different age groups. In childhood-onset autoimmune diseases, the sex bias is generally less evident than in adults, probably for the different hormonal milieau, being estrogens strongly implicated in the development of autoimmunity. Still, some rheumatic conditions, such as juvenile idiopathic arthritis (JIA), show a strong predilection for girls (F:M = 3–6.6:1), and differences may coexist between males and females regarding disease outcome. For example, chronic anterior uveitis associated with JIA affects more commonly girls but boys tend to have a more severe course. Systemic lupus erythematosus predominantly affects girls and women (F:M = 3–5:1 in children, F:M = 10–15:1 in adults). Behςet's disease has been reported to be more prevalent in adult males (F:M = 1:1–4); in children, there are no differences. The sex ratio is equal in children and adults for Henoch-Schönlein purpura (F:M = 1:1). A higher male-to-female ratio exists for Kawasaki disease (F:M = 1:1.1–1.6 in children, F:M = 1:1,5 in adults). Juvenile dermatomyositis (F:M = 2–5:1), systemic sclerosis (F:M = 4:1 in children, F:M = 6:1 in adults), and Takayasu arteritis (F:M = 2:1 in children, F:M = 7–9:1 in adults) are more common in girls and women then in boys and men. There is no gender bias for acute rheumatic fever in children, while in adults, the F:M ratio is 2:1. Given that estrogen levels are not different between genders during childhood, pediatric rheumatic diseases could represent good models to study other mechanisms related to the development of autoimmunity. Recently, the levels of miRNA expression, and their variation according to sex chromosomes, have been linked to the development of autoimmune diseases, with different impact among sexes. This review will focus not only on the sex bias reported in the more common rheumatic conditions of childhood, focusing on differences in incidence, but also on outcome and trying to depict the mechanisms underlying those differences.
http://ift.tt/2wCNSgJ
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